| Private Pay |
|---|
| Insurer Policy |
Private Pay |
| Insurer Status | Denied after first letter (08/24/04) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
42.3 |
| Source |
Teri D |
| Regence, medicare,medicaid |
|---|
| Insurer Policy |
Regence, medicare,medicaid (PPO) |
| Insurer Status | |
| Surgery Type |
Laparoscopic RNY |
| Source |
Earnestine J |
| - CASH PAY - |
|---|
| Insurer Policy |
- CASH PAY - |
| Insurer Status | (01/10/06) |
| Surgery Type |
Laparoscopic Lap Band |
| Comorbidities |
Depression, Hypercholesterolemia, Shortness of breath, Sleep apnea, Stress incontinence |
| Policy |
Written exclusion policy |
| Source |
April S |
| Administrators West |
|---|
| Insurer Policy |
Administrators West (ppo) |
| Insurer Status | Denied after first letter (10/02/01) |
| MD-supervised programs |
2 (14 weeks) |
| Source |
Christine N |
| Aetna |
|---|
| Insurer Policy |
Aetna (Microsoft) |
| Insurer Status | Approved after appeal letter (10/1/99) |
| MD-supervised programs |
2 (86 weeks) |
| Comorbidities |
sleep apnea |
| Policy |
Written exclusion policy |
| Comments |
Although Aetna initially denied, when they forwarded my request to Microsoft for review, I was quickly approved. I've heard that the written exclusion is in the process of being removed from Microsoft's policy with Aetna. Dr. Weber's office was extremely helpful and efficient in seeing my case through. |
| Source |
Judith B |
| Insurer Policy |
Aetna (not sure) |
| Insurer Status | Approved after first letter (Nov. 99) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
45.6 |
| Comorbidities |
sleep disorder, knee pain, reflux |
| Policy |
Must be medically necessary |
| Comments |
I had absolutely no problems with Aetna. My Dr. simply wrote the letter and I was approved! I know I'm among the lucky few. I know that part of it is that my husband's company (AT&T) has a very good policy through them. I would highly recommend them to anyone. |
| Source |
LuAnn L |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after 2nd appeal letter (8-24-99) |
| Source |
Iris T |
| Insurer Policy |
Aetna (Microsoft) |
| Insurer Status | Approved after first letter (08/19/99) |
| MD-supervised programs |
1 (24 weeks) |
| Source |
Sue F |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (08/27/99) |
| Weeks to approval |
1 |
| Comorbidities |
Sleep Apnea, Diabetes, GERD, Back & Knee Pain |
| Policy |
Written exclusion policy |
| Comments |
We have our policy through our employers - the State of Washington. Even though there was a written exclusion it went through just fine - no hassles no delays - NO PROBLEMS. Don't let the written exclusion scare you away. When I called the office they said it would have to be approved by the medical board and it would have to be medically necessary. Aetna covers this surgery under other plans and I'm not sure if this was helpful or not. |
| Source |
Melinda C |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/19/99) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
46.6 |
| MD-supervised programs |
4 (56 weeks) |
| Comorbidities |
arthirtis, plantar fascitis, hypertension and gerd |
| Policy |
Written exclusion policy |
| Comments |
My letter was faxed to my insurance late on a Friday night and on Wednesday my doctors office was calling me and telling me I had been approved..I had all my paperwork done, copies of medical reports, letters from physicians, 5 year weight history showing intervention from doctors. |
| Source |
Teri S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (12/15/99) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| MD-supervised programs |
3 (52 weeks) |
| Comorbidities |
arthritis, hypertension & GERD |
| Policy |
Don't know |
| Comments |
They were great as long as I was using a surgeon
from Virginia Mason. They approved me in 3 weeks!
The co-morbidites and family history of obesity
and obesity-related illness was crucial to the
approval process as I am "only" (can you believe
that?) 100 lbs overweight. |
| Source |
Carol W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (10/01/2000) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
54.8 |
| Policy |
Must be medically necessary |
| Comments |
My insurance is through my employer, the Federal Government. I had been thinking about this surgery for a couple of years, but it wasn't until calendar year 2000 that ALL of the health plans we can choose from include "surgical treatment for morbid obesity." That's when I decided to pursue WLS. Since Aetna MUST cover the surgery under the Fed Government plan, I was approved in less than 2 weeks. |
| Source |
Gail A |
| Insurer Policy |
Aetna (WT PLUS PLAN Group# F28) |
| Insurer Status | Denied after first letter (06/17/03) |
| Comorbidities |
sleep apnea, hypertension, joint deterioration, GERD, borderline diabetic |
| Policy |
Written exclusion policy |
| Comments |
So far my insurance has told me that there is an exclusion in my policy for the treatment of obesity. Basically they say they will not cover it in any way, shape or form & specifically will not cover a gastric bypass when related to weight loss, even if related to illness or injury where weightloss would directly affect my well-being. |
| Source |
Ryan P |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (2/14/2001) |
| Surgery Type |
Laparoscopic RNY - distal |
| Pre-Op BMI |
43.8 |
| MD-supervised programs |
2 (28 weeks) |
| Comorbidities |
Alpha Intrusion, chronic back, knee and ankle pain |
| Policy |
Must be medically necessary |
| Comments |
What can I say about Aetna......well I must say that if your dealing with an Ins. Company it takes persistence!! I called them every day 5 times a day and after going from person to person I finally met two wonderful people who helped me getting approved Susan Tiley and jaquline!! they were great!! I must say that I had no real problems with them but you also have to understand they were all probably tired of hearing from me too !! LOL As for recommending Aetna to anyone YES i would overall they are good to work with and very freindly to WLS |
| Source |
Bridgett M |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (12/29/99) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Comorbidities |
Sleep Apnea, Arthritis, |
| Source |
Kim S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (02/04/02) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
71.4 |
| Comorbidities |
sleep apnea, hernia form previous VBG, asthma, BMI 53, problems with knees |
| Policy |
Must be medically necessary |
| Comments |
3/25/00 My insurance company denied me. What a let down. I have contacted my Dr. and they will start the appeal process. I am also writing a letter of appeal myself. I have a second insurance, Indian Health, I am in the process of trying to get approval with them at the same time I am trying to get Blue Cross to approve. I can't stand the waiting. I am hoping they will approve with persistance. I have some problems from a VBG done in 96. I was hoping to have this done over spring break which is the first week in april. Doesn't look like that is going to happen. Hope it is soon!! Cindy 11/19/00 I have found out that I can get Aethna through Basic Health without any waiting period. The reason is because I am a licensed Foster Parent. I just happened to run across that information. I have been approved for the insurance starting Dec. 1. I have gone to my PCP and he thinks that the revision will be a good idea. So now it is just getting the ball rolling. I think I have decided to go with Dr. Oh in Federal Way Wa. I have decided against Dr. Ross Fox. It seems that they are interested in money to much. I think he is no doubt a good surgeon, but I think Dr. Oh will do fine. I am hoping for a 48 hour desision from my insurance because of all the problems I have had with nausea and vomiting. I understand that if the Doctor tells the insurance co. that it is neccesary to speed up the process then they have to do that. I am hoping for Christmas vacation for a surgery date. I need to call this week to see if I can get things going. I sure hope so. Also my sister has just found out her Hubby's insurance covers this surgery. So we are hoping to make this journey togeather. I sure hope so. Can't wait!!!!!!!!!!! Cin
Feb.4,02
Finally I have a surgery date! March 5th, 02. I had to move to the Seattle area and change Basic Health Aetna to regular Aetna. Because I moved to the Seattle area I was able to change insurance to Aetna. I was taken of work because of injury to my knees, so I decided to move to the Seattle area so I could get the insurance I needed to get this surgery! It worked. It only took a couple of weeks to get approved, and this is for a revision. I am so excited!! I can hardly wait. My sister, Tammy Lunda had surgery on Dec, 20, so we will be making this journey togeather. She has lost 27 pounds to date. For those who live in Eastern Wa. and have not where to turn, remember that safeway insurance will pay for this surgery. That was my back up plan. Don't give up, where there is a will there is a way.
Later
Cin
4-12-02
I have a new surgery date. My surgery on march 7th was aborted because of severe bronchial spasams. I now have a new surgeon, Dr. Somotowiz, in Bellevue Wa. I will have surgery next Tuesday at 12pm, at Overlake hospital. Dr. Oh wanted to refere me to the University of Wa. which has a 12 to 18 month waiting list just for a consult. So I found a Dr. who would do me this month. I am so thankful for my Dr. I really like him. Talk with everyone later.
Later.
Cin |
| Source |
Cindy S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (5/99) |
| Surgery Type |
Open Other |
| Weeks to approval |
1 |
| Pre-Op BMI |
64.4 |
| Comorbidities |
knee problems, rashes |
| Policy |
Must be medically necessary |
| Source |
Juley T |
| Insurer Policy |
Aetna (us) |
| Insurer Status | Approved after first letter (02/24/00) |
| Surgery Type |
Open VBG |
| Weeks to approval |
3 |
| Pre-Op BMI |
42.6 |
| MD-supervised programs |
6 0 |
| Comorbidities |
NONE |
| Policy |
Must be medically necessary |
| Comments |
they did not seem to stall . the only dealy was from my surgeons office. paperwork was misplaced and after it was refaxed, i received my approval the next day!they had a written exclusion that they did away with and they have a policy that is very liberal and supportive of obesity surgery. they even quote the surgeon generals findings on obesity surgery on their web site.check out aetnas own web site and type in"obesity surgery" they list the qualifications for approval. |
| Source |
Roberta K |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (03/14/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
1 |
| Comorbidities |
none |
| Policy |
Must be medically necessary |
| Comments |
No problems. I was lucky. I am thankful |
| Source |
Theres S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/29/00) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
40.7 |
| Comorbidities |
sleep apnea, arthritis |
| Policy |
Must be medically necessary |
| Comments |
For the most part they were good to work with. I don't think they stalled, but i did call daily after the two weeks were up; took about 4 days after that for the approval. |
| Source |
Melissa R |
| Insurer Policy |
Aetna (PEBB) |
| Insurer Status | Approved after first letter (06/01/2002) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Pre-Op BMI |
47.9 |
| Comorbidities |
hypertension |
| Policy |
Written exclusion policy |
| Comments |
It was too easy. I didn't have to send anything verify diet history, past attempts at weight loss, etc. My doctor submitted the paperwork after my consultation without my knowledge. At my consultation, my doctor had asked me to get copies of my diet history, medications, health problems, etc. and send it to them so they could submit it with their paperwork to Aetna. About two weeks later I checked my mail and there was an approval letter from Aetna. |
| Source |
Stephanie S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (04/11/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
3 |
| Pre-Op BMI |
51.4 |
| Comorbidities |
hypertension and back pain |
| Policy |
Don't know |
| Comments |
Good |
| Source |
Valerie S |
| Insurer Policy |
Aetna (microsoft) |
| Insurer Status | Approved after first letter (9/15/2000) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
2 |
| Comorbidities |
none |
| Policy |
Must be medically necessary |
| Comments |
It was almost TOO easy.... I went to the dr on Sept 6th and my approval letter was dated 9-15. I am covered 100% no out of pocket because my surgeon (Dr Thirlby) is within Network. |
| Source |
Beth L |
| Insurer Policy |
Aetna (U.S. Healthcare MC) |
| Insurer Status | Approved after first letter (06/30/00) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Weeks to approval |
2 |
| MD-supervised programs |
1 (4 weeks) |
| Comorbidities |
Sleep Apnea, GERD, arthritis, family history of morbid obesity |
| Policy |
Must be medically necessary |
| Source |
Laura A |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Denied after 2nd appeal letter (7/24) |
| Surgery Type |
Laparoscopic Lap Band |
| Pre-Op BMI |
43.9 |
| Comorbidities |
Diabetes, Gerd, sleep apnea |
| Policy |
Written exclusion policy |
| Comments |
It has been a nightmare. I was orginally told WLS was an excluded procedure. Then they approved me. After I was approved I got a call saying I should not have been approved. Dr.Oh's office called Aetna and were told that I WAS approved and to go ahead with the procedure.
Two days before my surgery date of 7/24, Aetna told the hospital I did not have coverage. Surgery was cancelled and Aetna now says I can appeal if I want.
It has been a roller coaster and I am so upset about getting so close to the surgery only to be turned away at the last minute. |
| Source |
Cheri M |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/19/00) |
| Surgery Type |
RNY - proximal |
| MD-supervised programs |
1 (60 weeks) |
| Source |
Susi B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/26/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Comorbidities |
No - Co-morbiditeis |
| Comments |
Approved in 10 days! Insurance company very nice to deal with. Very responsive!! |
| Source |
Cathy W |
| Insurer Policy |
Aetna (Microsoft) |
| Insurer Status | Approved after first letter (01/29/01) |
| Surgery Type |
Open VBG |
| Pre-Op BMI |
42.9 |
| MD-supervised programs |
3 (200 weeks) |
| Comorbidities |
Sleep apnea, GERD, high cholesterol, diabetes |
| Policy |
Must be medically necessary |
| Comments |
I've finally gotten out of the Regence hole and have been insured with Aetna since 12/04/00. They were very helpful and approved my surgery almost immediately. They require pretty standard stuff--BMI of 40 or higher, or 35+ with severe co-morbidities, and a documented history of repeated weight-loss failure. Their attitude is refreshing: let's do what we have to do to ensure this person's continued health. |
| Source |
Suzanne B |
| Insurer Policy |
Aetna (Healthy Options) |
| Insurer Status | Approved after appeal letter (06/20/00) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
42.9 |
| Policy |
Must be medically necessary |
| Comments |
After doing research, it appears that Aetna
is one of the easier companies to deal with
concerning bariatric surgery. From the time
I first asked my PCP for a referral, the denial
by Pro Health Alliance (Aetnas management
Company) to the appeal and approval took about
two months. I WAS VERY PERSISTANT. |
| Source |
Brenda T |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (11/30/00) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
48.4 |
| MD-supervised programs |
2 (32 weeks) |
| Comorbidities |
hypertension, diabetes, back and foot problems |
| Policy |
Don't know |
| Comments |
I had Premara Healthplus coverage but found a written exclusion in the handbook so I switched to Aetna HMO hoping they will cover it. I couldn't find an exclusion in all the material I received, but we'll see if they cover this. I will probably call them in January when coverage is effective to see what they say. |
| Source |
Kris S |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/20/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
50.6 |
| Comorbidities |
Sleep apnea, shortness of breath, gallstones |
| Policy |
Must be medically necessary |
| Comments |
No problem with the insurance company, but ask me about the office staff of my surgeon!! But, that's another story. The insurance company routinely approved me 1 week after they received the paperwork. Now, if I can just get a surgery date!! |
| Source |
Linda M |
| Insurer Policy |
Aetna (Golden Medicare) |
| Insurer Status | Approved after first letter (08/20/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
12 |
| Pre-Op BMI |
77.9 |
| Comorbidities |
sleep apnea, lupus, |
| Policy |
Must be medically necessary |
| Comments |
For some reason the best excuse they could give, was "No, I never received that Fax" Seems like the surgeons office and myself had to fax all the information more than once.
There were weekly calls to try and get an answer. Many times, it was I cannot give you that information only to the surgeons office can I release that information.
Very frustrating. I would reccommend them, because it seems like they are the only ones who do not outright exclude the surgery. |
| Source |
Judy D |
| Insurer Policy |
Aetna (Patriot X HMO) |
| Insurer Status | Approved after first letter (03/25/01) |
| MD-supervised programs |
2 (30 weeks) |
| Source |
Valorie R |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (09/02/00) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
3 |
| Pre-Op BMI |
43.2 |
| Comorbidities |
Sleep apnea, shortness of breath, massive back problems |
| Policy |
Written exclusion policy |
| Comments |
It's actually funny, Microsoft has an exclusion policy that Aetna ignores. |
| Source |
Michael B |
| Insurer Policy |
Aetna (KING CARE) |
| Insurer Status | Approved after first letter (11/27/00) |
| Surgery Type |
RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
41.2 |
| MD-supervised programs |
2 (20 weeks) |
| Comorbidities |
DIABETIES, HYPERTENSION, GERD, HEART ATTACK |
| Policy |
Written exclusion policy |
| Comments |
WHEN I FIRST CALLED, THEY SAID THAT ANY OBESITY RELATED CLAIMES WERE/ARE NOT COVERED. THEN I CHECKED ABOUT MORBID OBESITY AND YEP! AS LONG AS IT WAS MEDICALLY NECESSARY!
I DID EVERTHING POSSIBLE TO ASSIST MY SURGEON TO GET THIS APPROVED. i VISITED MY CARDIOLIGIST, AND WE SPKE AT LENGTH. HE DID SOME TESTS, THEN WROTE A LETTER SAYING THE SURGERY IS IMPARITIVE TO MY CARDIAC HEALTH. MY PCP HAS NEVER SUPPORTED ANYONE BEFORE ME, AND WAS VERY IMPRESSED WITH MY RESEARCH WHICH IN TURN MADE HER WANT TO RESEARCH AND SHE WROTE ME A GREAT LETTER! ALSO HAD A PHYC EVAL THAT WAS LONG AND BORING BUT WENT WELL TOO.
TO MAKE A LONG STORY SHORT, I HELPED MY SURGEON TO MAKE SURE ALL BASES WERE COVERED, SO THAT HE COULD MAKE SURE THAT ALL THE I'S WERE DOTTED AND THE T'S WERE CROSSED!
THE INSURANCE COMPANY LOST MY PAPERS TWICE. I STAYED ON THEM AND THE MANAGER OF CUSTOMER SERVES BECAME INVOLVED. WITH HER HELP IT WAS ALL HANDLED AND APPROVED. IT WAS SCARY CONSIDERING THEY TOOK UNTIL 5 DAYS PRIOR TO SURGERY TO ARRROVE ME! BUT THEY DID!
MY ADVICE......PERSISTENCE AND PAST MEDICAL DATA IS THE KEY! |
| Source |
Candace M |
| Insurer Policy |
Aetna (Microsoft PPO) |
| Insurer Status | Approved after first letter (09/13/00) |
| Surgery Type |
Open RNY |
| Weeks to approval |
5 |
| Comorbidities |
diabetes, hypertension |
| Policy |
Don't know |
| Comments |
No problems. After they received all the
info from the Doctor, they approved me in
two days. Process: My PPO doctor referred
me to Dr. Simonowitz. Dr. Simonowitz saw me
and wrote a letter to the insurance
company. They requested medical documentation of my history from my PPO
Doctor. They requested that I list for them
all the diets, programs, etc. I had tried.
That info was faxed to them and in two days
I received my approval. |
| Source |
Catherine M |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (11/16/01) |
| Surgery Type |
Open RNY - distal |
| Pre-Op BMI |
48.7 |
| MD-supervised programs |
2 (64 weeks) |
| Comorbidities |
GERD, Back Pain, Morbidly Obese |
| Policy |
Must be medically necessary |
| Comments |
11/20-So far Aetna has been very helpful. It is my PCP that has been kind of a pain. The person submitting the request for a referral wanted all this additional information from me and it was really unnecessary...She totally dropped the ball on getting the information out last week, so I saw my surgeon without a referral, which she will retro? Anyway, I called the office today and she stated she faxed the info. Just from all of the information I have gathered here, I decided to call the insurance co and make sure she did it. They received it and said there would be a referral within 5 business days. Good news for today, anyway. |
| Source |
Melissa S |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/09/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
7 |
| Pre-Op BMI |
49.4 |
| MD-supervised programs |
1 (52 weeks) |
| Comorbidities |
hypertension, mild sleep apnea, gall stones, high colesterol |
| Policy |
Must be medically necessary |
| Comments |
I haven't called to "bug" them yet ;0)...UPDATE: 4/07...I have called and called and called again! This is frustrating!! FOUR weeks after Pam (from Dr. Weber's) sending the information (note: she also faxed them twice!) my information was FINALLY logged in for medical review on Friday. Hopefully is won't be too much longer! 4/17...finally approved. 4/23...Yea, well I thought I was finally approved because foolish me took the word of Aetna's customer service department. I had two different people there tell me "the letter is in the mail." Of course it wasn't I am not approved. All I have to say is that Aetna has a very poorly trained customer service department. It seems as though they do not care about their policy holders and there is NO one to complain to that actually cares or takes you seriously. I would NEVER recommend Aetna to anyone. If you have the option of another insurance company that covers this surgery go with them!! 4/25...got the letter in the mail...I AM APPROVED!!! NOW I finally believe it!!! Waiting for a surgery date...hopefully I will know on Friday! 4/30...surgery date 6/11! WOOHOO...FINALLY! 5/30...I guess I should actually be grateful that I had an insurance company that covered this surgery. I had a long period to wait for my approval, but at least I was not denied like some people. I am grateful. Good luck to those still persuing insurance approval. |
| Source |
Jeanese M |
| Insurer Policy |
Aetna (point of service) |
| Insurer Status | Approved after first letter (03/31/01) |
| Surgery Type |
Open VBG |
| Weeks to approval |
5 |
| Pre-Op BMI |
44.5 |
| MD-supervised programs |
2 (88 weeks) |
| Comorbidities |
hypertension, arthritis |
| Policy |
Must be medically necessary |
| Comments |
My Dr's office submitted all documentation, twice. I called almost every day and talked to so many different people. Very frustrating. Persistence is the key word. |
| Source |
Jill F |
| Insurer Policy |
Aetna (MC) |
| Insurer Status | Approved after first letter (10/31/00) |
| Source |
Kellie P |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after appeal letter (12/11/00) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
1 |
| Pre-Op BMI |
46.8 |
| Policy |
Must be medically necessary |
| Comments |
I just started my policy as of December 1st and had trouble finding a primary care physician. Aetna was great at helping me. I specifically talked to a gentleman named Jack and he was patient and very informative. I don't see a problem.
Jan 8th, 2001. I've been approved and it seemed so easy. but then again I met all the criteria. I am so excited but scared. I talk to Dr. Oh on the 10th of January to go over everything. I can't wait. Seven more days till surgery. I have been busy with appointments, Psychologist, nutritionist, pre-ops, abd and pelvic ultrasounds, edg, ekg, chest exrays,blood work, consultations with hospital and many Dr.visits. Dr. Oh is so very thorough. Im very glad I have him as a doctor. |
| Source |
Holly D |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (4/24/01) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
61.4 |
| MD-supervised programs |
1 (16 weeks) |
| Comorbidities |
Sleep Apnea, high cholesterol |
| Policy |
Don't know |
| Comments |
12/06/00 - Well, looks like my company will be switching to Aetna US Healthcare. (Had BCBS of CA) I think I will choose the PPO plan rather than the HMO plan. It will cost me more out of pocket, but I won't have to get referrals and can still see doctors out-of-network if I choose. The good news is that I've seen many people on this website have Aetna Health insurance. They seem to get approved with little or no problem.
11/12/00 - Have BCBS of CA. Must be medically necessary.
01/15/01 -- Aetna insurance effective Jan 2001. I have contacted our Aetna rep for our company. He's been very nice and helpful. He's placing the call to the patient care folks to see if WLS is covered. I gave him the procedure code and diagnostic code. I should find out tomorrow if there is a direct exclusion or not.
** 3/12/01 -- All insurance information mailed off to insurance from Dr. Weber's office.
3/22/01 -- checked with the insurance for the 3rd or 4th time since Pam sent the info in. They said I'm approved for the hospital stay, but that it doesn't say how many days or what procedure. When I called Pam @ Dr. Weber's office to discuss this with her, she informed me there are THREE steps for approval. 1) Pre-determination 2) Pre-authorization 3) Pre-Certification. Apparently I'm pre-authorized. I'm assuming I've got the pre-determination. Now, just waiting for the official pre-certification.
4/2 - I find out that the Doctor's office has accidentally sent my paperwork to the San Diego office rather than the Seattle office. (3 weeks WASTED because of that.) Paperwork RE-FAXED to insurance company (all 19 pages). 4/3 - Info supposedly routed to medical review.
4/12/01 - Called yet again. Still no sign that any paperwork has been received in Medical Review. Paperwork gets submitted a THIRD time. I have to specifically ask my contact at Aetna to call the person in medical review to make sure she received it! 4/13 - 4/24 - I called everyday to check status. Tried to talk to the same person each time. (made things a whole lot easier!)-- was getting extremely frustrated at hearing a different story each time I called, depending on who I was talking to.
4/25 - FINALLY when I call they go searching for the information and find that yes, I AM APPROVED!!! When I get home, the letter of approval is in my mailbox, waiting for me. (Thinking about having that baby framed!)
*** I felt like they gave me the run around bigtime. I tried to get anyone and everyone involved that I could to try to put pressure on the insurance company. I even spoke to my companies plan administrator. **
I'm approved and that's what matters!
|
| Source |
Heather B |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/30/00) |
| Surgery Type |
Open Other |
| Weeks to approval |
4 |
| Pre-Op BMI |
53.3 |
| Comorbidities |
asthma, pain in back and knees |
| Policy |
Don't know |
| Source |
Leesa R |
| Insurer Policy |
Aetna (Managed Choice) |
| Insurer Status | Approved after first letter (03/06/01) |
| Surgery Type |
Open RNY - distal |
| Weeks to approval |
1 |
| Comorbidities |
Borderline Diabetic, problems sleeping, joint soreness, snoring, acid reflux. |
| Policy |
Must be medically necessary |
| Comments |
I think Aetna is an excellent insurance. They've been nothing but polite when I call them. I was even told by one of the persons that I spoke to that he would pray for me. I think that is amazing. I'm very impressed. I GOT MY APPROVAL AFTER ONLY 2 DAYS. Aetna is the greatest. |
| Source |
Charlotte H |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (01/14/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
44.4 |
| Policy |
Must be medically necessary |
| Comments |
Aetna was great to work with. I called in every other day to check on my claim. A few times I called, I was connected to not so nice people. On my last call to Aetna, I got in touch with a wonderful operator. She kept me very informed! Thank you tons Amy!!
I was approved in only 2 weeks, however let me tell you that it seemed like an eternity.
I was affraid that they would deny me due to the fact that I am a new policy holder. That didn't seem to be a problem. Way to go AETNA and AMY!!! I would recommend Aetna to anyone. |
| Source |
Heidi P |
| Insurer Policy |
Aetna (ushealthcare) |
| Insurer Status | Approved after first letter (02/06/01) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
48.7 |
| Source |
Debra G |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (05/24/02) |
| Surgery Type |
Open RNY - proximal |
| Pre-Op BMI |
54.0 |
| MD-supervised programs |
1 (2 weeks) |
| Comorbidities |
Sleep Apnea, GERD, back pain, enlarged heart,beginning stages of arthritis |
| Policy |
Must be medically necessary |
| Comments |
Aetna is the greatest insurance company for this type of surgery. It only took 6 days. Every person I spoke to regarding my status was absolutely wonderful. Not one rude person. They did not stall or lose paperwork and I did not have a single problem. I would recommend this company to everyone wanting weight loss surgery. |
| Source |
Michelle J |
| Insurer Policy |
Aetna (Patriot) |
| Insurer Status | Approved after first letter (10/06/01) |
| Surgery Type |
Open RNY - proximal |
| MD-supervised programs |
1 (20 weeks) |
| Source |
Delores H |
| Insurer Policy |
Aetna (US Healthcare) |
| Insurer Status | Approved after first letter (03/11/01) |
| Surgery Type |
Open RNY |
| Weeks to approval |
3 |
| Pre-Op BMI |
40.5 |
| Comorbidities |
Acid Reflux, posterior pharyngitis, radiculopathy |
| Comments |
Beacuse this is an HMO, Virginia Mason has it own referral coordination with Aetna. It was VMC that stalled for a couple of weeks |
| Source |
L M |
| Insurer Policy |
Aetna (HMO) |
| Insurer Status | Approved after first letter (03/09/01) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
54.8 |
| Policy |
Must be medically necessary |
| Source |
Erika M |
