| (Federal) |
|---|
| Insurer Policy |
(Federal) (Optima) |
| Insurer Status | Approved after first letter (04/26/02) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Source |
Anthony P |
| (Not yet) |
|---|
| Insurer Policy |
(Not yet) |
| Insurer Status | Approved after first letter (08/08/00) |
| MD-supervised programs |
5 (72 weeks) |
| Source |
Jane D |
| ? |
|---|
| Insurer Policy |
? (?) |
| Insurer Status | Approved after first letter (05/30/01) |
| Surgery Type |
Open VBG |
| Weeks to approval |
12 |
| Comorbidities |
sleep apnea, back problems breathing problems incontnience |
| Policy |
Don't know |
| Comments |
It was a great hassel
the stalled about 6 weeks
No Not at all
I recommend they put their selves in OUR place, waiting was the worst part! |
| Source |
Shea F |
| Acordia |
|---|
| Insurer Policy |
Acordia |
| Insurer Status | Approved (04/1995) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
40.0 |
| Comments |
I was approved within a month without any difficulty. I wound up paying only $1500.00 and the rest was covered by the insurance company. |
| Source |
Lorinda M |
| Insurer Policy |
Acordia |
| Insurer Status | Approved after first letter (05/28/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
12 |
| Pre-Op BMI |
66.1 |
| Comorbidities |
Arthritis |
| Policy |
Don't know |
| Comments |
Well I called at least 3x per week. I had my human resources department also place calls on my behalf. We are a little different in that our company fully funds the insurance co., so even if they had denied the authorization, I could have appealed via the VP Human Resources and he could overturn. I do however sense that the insurance co. respond to persistence and that they stall as long as possible. |
| Source |
Debbie R |
| Insurer Policy |
Acordia (PHO) |
| Insurer Status | Approved after first letter (01/10/02) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
63.2 |
| Comorbidities |
Diabetes, arthritis |
| Policy |
Must be medically necessary |
| Comments |
I had no problems with Accordia, as soon as they received all required reports and letters I was approved. Actually I was told I would be approved before any letters were sent, but they have to go through the correct process. |
| Source |
Shirley L |
| Insurer Policy |
Acordia |
| Insurer Status | Approved after first letter (4/15/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
5 |
| Pre-Op BMI |
58.0 |
| Comorbidities |
HYPERTENSION CHF SLEEP APNEA |
| Policy |
Must be medically necessary |
| Comments |
MY INSURANCE WAS A PLEASANT EXPERIENCE STALLING WAS NON-EXISTANT |
| Source |
Eric F |
| Insurer Policy |
Acordia (ppo) |
| Insurer Status | Approved after first letter (07/30/03) |
| Surgery Type |
Laparoscopic RNY |
| Source |
David P |
| Insurer Policy |
Acordia |
| Insurer Status | Approved after first letter (12/27/03) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
52.2 |
| Source |
Tricialyn R |
| Insurer Policy |
Acordia (Alliance PPO) |
| Insurer Status | Approved after 2nd appeal letter (09/03/2004) |
| Surgery Type |
Open RNY |
| Weeks to approval |
9 |
| Pre-Op BMI |
41.5 |
| MD-supervised programs |
1 (32 weeks) |
| Comorbidities |
arthritis,asthma,hypertension,high triglycerides and cholesterol |
| Policy |
Must be medically necessary |
| Comments |
Customer service reps are pleasant, helpful, and willing to check into precert and call the surgeons office for all that was needed. At first I thought they were stalling, but realized they truly needed weight documentation for several years back.
My recommendation is to be persistant and stay on top of insurance company and surgeons office. |
| Source |
Ginny F |
| Acordia National (perdue Farms Inc) |
|---|
| Insurer Policy |
Acordia National (perdue Farms Inc) |
| Insurer Status | Denied after first letter (12/29/05) |
| Comorbidities |
Depression, Diabetes, GERD, Hypertension, Obesity hypoventilation syndrome, Shortness of breath |
| Source |
Ashley C |
| ACS Benefits |
|---|
| Insurer Policy |
ACS Benefits |
| Insurer Status | Approved after first letter (09/18/04) |
| Policy |
Must be medically necessary |
| Comments |
I never really had to deal with my insurance Dr. Davies office took care of all the paper work and everything else. I heard back from my insurance after a couple of months. I did have to go to a shrink. |
| Source |
Amy A |
| ACS Consulting |
|---|
| Insurer Policy |
ACS Consulting |
| Insurer Status | Approved after first letter (10/21/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
16 |
| Pre-Op BMI |
46.3 |
| Comorbidities |
Asthma, GERD, DJD, COPD |
| Policy |
Must be medically necessary |
| Comments |
My insurance company representative was friendly each time I called. But, I do feel that the company was stalling on my approval. They denied receiving one of the letters from Dr. Kellums office, but Yolanda kindly faxed them another. I called my insurance company at least twice a week to check on the status of my approval. They actually returned my calls when I got a machine instead of a person. Overall, I would say this insurance company responds positively to persistence. (Maybe they were just tired of me calling). 12/27/01 : I was very impressed with my insurance companys payment on my surgery, I was expecting to owe a considerable amount of money for things they would not cover. However, I received my statement from the insurance company today and all I owed the hospital was 9 dollars out of 25,000. I do have to pay 800 dollars of my surgeons fee, but that is a small price to pay for this life changing surgery. |
| Source |
Sherry G |
| Administrative Solutions |
|---|
| Insurer Policy |
Administrative Solutions (virginia health networrk) |
| Insurer Status | First letter sent - still waiting (03/11/03) |
| MD-supervised programs |
2 (23 weeks) |
| Source |
Tracey B |
| Adventist Health |
|---|
| Insurer Policy |
Adventist Health |
| Insurer Status | Approved after first letter (08/11/01) |
| Source |
Michael M |
| Aenta |
|---|
| Insurer Policy |
Aenta (PPO) |
| Insurer Status | Approved after first letter (07/15/05) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Comorbidities |
Hypertension |
| Policy |
Must be medically necessary |
| Comments |
Aetna was great, I never dealt with them at all. |
| Source |
Blessed not Stressed |
| Aetna |
|---|
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Comments |
Had no problems getting approved. |
| Source |
Lisa M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Surgery Type |
Open RNY |
| Comments |
It was approved with no problem.. As long as you
are 100 lbs over your ideal weight. It was not
in my policy exclusion list. |
| Source |
Caren M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved |
| Comments |
Approved within 4 business days |
| Source |
Simonne B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (11/01/99) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
10 |
| Pre-Op BMI |
50.0 |
| Source |
Jennifer R |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
52.5 |
| Source |
Jody M |
| Insurer Policy |
Aetna (J Crew (self insured)) |
| Insurer Status | Denied after appeal letter |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
87.7 |
| Comments |
My insurance is Aetna US Healthcare and I understand that this procedure is paid for by Aetna US Healthcare. The problem I am seeming to have is that the company I worked for, J Crew, is a self-insured company and just uses Aetna to administer their policy. They say in their policy they will not do stomach-stapling. This gastric bypass is not stomach-stapling as far as I see it. It does involve putting some staples in my stomach and then cutting my lower stomach from my new pouch and then re-routing some tubing so that I can live and walk again. I wish they could see my life now and what it will be like after surgery. It will ultimately save the insurance companies alot of money to pay for this procedure. My knees are failing, I have venous insufficiency, sleep apnea. I can only walk about 200 feet before I must sit and rest.
From what I hear, Aetna US Healthcare is a good company and would cover it, but can not since J Crew calls the shots. Several people I have talked with there were very empathetic but could not help. |
| Source |
James |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (07/17/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
12 |
| Pre-Op BMI |
56.0 |
| MD-supervised programs |
1 (28 weeks) |
| Comorbidities |
SLEEP APNEA ARTHRITIS,GERD AND HEEL SPURS |
| Policy |
Must be medically necessary |
| Source |
Virginia P |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/27/99) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
40.9 |
| Comorbidities |
Arthritis,high blood pressure, re-occuring kidney infections. |
| Policy |
Must be medically necessary |
| Comments |
I have Aetna Pos. They approved in only 4 days! I had a letter from my pcp,which I prepared and my pcp signed. I really did my homework. The bottom line is you sometimes have to take matters into your own hands. So far Aetna has been just great. I live in florida. |
| Source |
~Donna~ V |
| Insurer Policy |
Aetna (aetna) |
| Insurer Status | Approved after first letter (04/14/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
54.0 |
| Comorbidities |
sleep apnea, diabetes |
| Policy |
Must be medically necessary |
| Comments |
not bad
not bad
yes
write a very moving personal letter
|
| Source |
Diana D |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/20/99) |
| Surgery Type |
RNY - proximal |
| Weeks to approval |
3 |
| Pre-Op BMI |
48.7 |
| Comorbidities |
Hypertension, Arthritis, Myasthenia Gravis |
| Policy |
Must be medically necessary |
| Comments |
AETNA USHC was great. Only had to send them an updated Thyroid test and within 24 hours I was approved. They started reviewing the request on 31 Jan and asked for the test update on 2 Feb. I had it done by my PCP on 8 Feb and it was sent to AETNA the same day. Recommend staying close to the status. Call both the insurance company and the Doctor's office asking about the status and what you can do to assist all in the approval process. Provide well documented weight control and medical history and above all be nice to them and make them part of your team!! |
| Source |
Lenard D |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after 2nd appeal letter (02/13/00) |
| Source |
Dawn C |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (02/07/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
43.9 |
| MD-supervised programs |
1 (36 weeks) |
| Comorbidities |
asthma, GERD and sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
Luckly we had open enrollment this year and I was able to select Atena. I had tried to get approval with Cigna for over a year to no avail. I have nothing bu great things to say about Atena. |
| Source |
Robin R |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (09/15/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
49.2 |
| MD-supervised programs |
5 (64 weeks) |
| Comorbidities |
sleep apnea |
| Policy |
Must be medically necessary |
| Comments |
They stalled alittle but I called eveyday until I got my aproval. |
| Source |
Michelle R |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/23/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
44.3 |
| Comorbidities |
high blood pressure and staring to have problems with my knees |
| Source |
Deborah B |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | (04/23/00) |
| Surgery Type |
Laparoscopic Other |
| Pre-Op BMI |
41.3 |
| Comments |
I was self pay. |
| Source |
Shervelle M |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (07/28/00) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
2 |
| Comorbidities |
back pain |
| Comments |
I had no problems getting approved even though I do not have extensive co-morbidites. The doctor drafted the letter for me after soliciting some general infomraiton re: diet history and general health. I passed a physical with my PCP in May which indicated that I had no major health concerns other than obesity. |
| Source |
Angela J |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (04/26/00) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
67.4 |
| MD-supervised programs |
2 (38 weeks) |
| Source |
Evelyn W |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (05/22/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
1 |
| Comorbidities |
Nothing but Hypothroidism & Back spasms |
| Comments |
So far Aetna has been great one full solid
week it took to get approved. In there
booklet it states that they do cover WLS
and my experince with them has been great
so far so good they will cover all $.00 copay.
For hospital stay I have my regular copay of
$10.00 for office visits.
Aetna is #1 "for an HMO" |
| Source |
Heather S |
| Insurer Policy |
Aetna ("Managed Choice-Point of Servi) |
| Insurer Status | Denied after first letter (06/02/00) |
| MD-supervised programs |
2 (47 weeks) |
| Source |
Stuart E |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (03/01) |
| Surgery Type |
Open RNY - distal |
| Pre-Op BMI |
61.7 |
| Source |
Tammie B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (01/98) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
3 |
| Pre-Op BMI |
53.9 |
| Comorbidities |
None |
| Policy |
Must be medically necessary |
| Comments |
You must be 100 lbs. or more over your ideal weight, have co-morbidities (I was lucky) and have documentation of undergoing unsuccessfully other weight loss methods, doctor supervised or otherwise. I consider them to be reasonable, but you must be persistent. It's YOUR life, not theirs. |
| Source |
Mavis C |
| Insurer Policy |
Aetna (Optimum Choice) |
| Insurer Status | Approved after first letter (06/25/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
63.3 |
| Comorbidities |
Lower Extremity Joint issues, Back Pain, Asthma |
| Policy |
Must be medically necessary |
| Source |
Jan B |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after first letter (07/13/00) |
| Source |
Rochelle W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/15/00) |
| Surgery Type |
Open RNY |
| Comorbidities |
No co-morbidities. |
| Comments |
I was amazed to get a phone call from Dr. Anez' office
telling me that I was approved only two days
after my first appointment with him. |
| Source |
Cheryl K |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/11/02) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| MD-supervised programs |
1 (8 weeks) |
| Comorbidities |
Gerd, Chronic back pain, allergies, asthma, history of hypertension, and diabetes |
| Policy |
Must be medically necessary |
| Comments |
03/11/02 I didn't have to deal with them. My doctors assistant did all the work. I am glad that I switched insurances. Aetna, thank you. You are the best!!!!! After 4 wks, I was approved.
I have not dealt with them yet. I read other people experiences with them and it didn't seem very favorable. My doctor does deal with this insurance so I have to wait for my first appt and see what develops from there. 1/12/01 I had my appt today. dr anez staff is going to send in the letter for insurance approval. I hope I do get approve...I really want to have this surgery...Now all i have to do is wait for the good/bad news...
I was denied coverage because there is a written exclusion in my insurance policy. I decided to change insurance in Oct during my company's open enrollment. I am changing it from Mamsi/hmo to Aetna/ppo. I have read the notes on other members' encounters with aetna and everything seem pretty good. I guess it is worth the wait.
I recieved my new insurance card today. I switched from mamsi/hmo to Aetna/ppo. My new insurance is not effective til Jan 1, 2002. I will have to wait see how things go then. |
| Source |
Sharisse B |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (09/14/00) |
| Surgery Type |
Open Other |
| Weeks to approval |
1 |
| Policy |
Must be medically necessary |
| Source |
Lyn C |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (10/8/00 approx.) |
| Comorbidities |
Acid reflux, diabetes |
| Policy |
Must be medically necessary |
| Comments |
My doctors office did all the work. I didn't have to provide any documentation of diets or anything. I saw my Doctor on Thursday afternoon and the next Monday morning I got a call from them saying I was approved. |
| Source |
Helen N |
| Insurer Policy |
Aetna (hmo) |
| Insurer Status | Approved after first letter (03/05/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
39.8 |
| Comorbidities |
feet swelling, back problems, tiredness |
| Policy |
Must be medically necessary |
| Comments |
I have no complaints, after I had my appointment, it took 9 working days to get approval. I did nothing, the doctor's office took care of everything. I called my Insurance on the 9th night just to check the status and was told it was approved.
|
| Source |
Terry O |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | Approved after first letter (10/08/00) |
| Surgery Type |
Laparoscopic Duodenal Switch |
| Weeks to approval |
1 |
| Pre-Op BMI |
41.6 |
| MD-supervised programs |
3 (20 weeks) |
| Comorbidities |
snoring, asthma |
| Policy |
Must be medically necessary |
| Comments |
I didn't have to deal with Aetna at all. I had my initial consultation with Dr. Roll and 6 days later I got a call from Barbara stating that I had been approved and she had an approval number. It was awesome. I recommend Aetna to anyone. They are good with everything I have wanted to do.
When I switched doctors it was no problem and Aetna just transferred the approval to my new doctor. I never had to speak with them. But there is a warning...be prepared to pay for much of the pre-op stuff. I am getting bills in where Aetna only paid like $20 of a $200 bill...and I am responsible for the rest. I guess it depends on your plan too. |
| Source |
Anne D |
| Insurer Policy |
Aetna (Indemnity) |
| Insurer Status | Approved after appeal letter (11/02/00) |
| MD-supervised programs |
1 (26 weeks) |
| Source |
Sally P |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (03/23/01) |
| Surgery Type |
Open RNY |
| MD-supervised programs |
3 (24 weeks) |
| Comorbidities |
hypertension, arthritis, lower back & hip pain |
| Comments |
Provided thorough documentation, not lengthy just a complete accounting of weight loss attempts over the years.
Surgical Coordinator at GW advised me to tell any others interested in having the surgery to follow suit and provide good documentation! |
| Source |
Jeannette S |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (02/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
2? |
| Pre-Op BMI |
50.9 |
| Comorbidities |
arthritis, hypertension, knee pain, shortness of breath, no energy |
| Policy |
Must be medically necessary |
| Comments |
I had no problem being approved by Aetna. They responded quickly and positively. |
| Source |
Maureen C |
| Insurer Policy |
Aetna (epo) |
| Insurer Status | Approved after first letter (12/21/00) |
| MD-supervised programs |
1 (13 weeks) |
| Source |
Lisa M |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (4/97) |
| Surgery Type |
Open RNY |
| Weeks to approval |
4 |
| Pre-Op BMI |
64.2 |
| Comorbidities |
None |
| Policy |
Don't know |
| Comments |
My surgery was over 3 years ago. I understand that things happen more easily & quickly now.
Things I did to get approved:
Letter from my primary GP covering my lifelong attempts at weight loss (with no long term success)and my possible health risks; a psychological evaluation. |
| Source |
Sally W |
