| MEDICARE |
|---|
| Insurer Policy |
MEDICARE ( NETWORK HEALTH PLAN) |
| Insurer Status | Approved after first letter (02/06/06) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Depression, Hypercholesterolemia, Stress incontinence, Osteoarthritis, Spondylolosthesis |
| Policy |
Don't know |
| Comments |
'network health plan' had an exclusion but 'medicare' covered most of it, leaving us with about $1000 out of pocket. |
| Source |
Mardi G |
| Abri |
|---|
| Insurer Policy |
Abri |
| Insurer Status | Denied after 2nd appeal letter (03/14/05) |
| Surgery Type |
Laparoscopic Lap Band |
| Source |
Emilia N |
| Aetna |
|---|
| Insurer Policy |
Aetna (Graebel Companies) |
| Insurer Status | Approved |
| Comments |
For me, Aetna was wonderful! They approved me within 3 weeks. My policy required a $100/copay only. Every pre-op test requested by my surgeon, was authorized. |
| Source |
Rhenea F |
| Insurer Policy |
Aetna |
| Insurer Status | Approved |
| Comments |
Approved the surgery in about 4 weeks. No denial. |
| Source |
Tina H |
| Insurer Policy |
Aetna (Open PPO) |
| Insurer Status | Approved after first letter (3-9-01) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
45.0 |
| Policy |
Must be medically necessary |
| Comments |
After having my PCP send a letter, I was approved within days! |
| Source |
Jennifer D |
| Insurer Policy |
Aetna (Managed Choice) |
| Insurer Status | Approved after first letter (10/26/01) |
| Surgery Type |
Laparoscopic RNY - proximal |
| Pre-Op BMI |
40.1 |
| MD-supervised programs |
5 (30 weeks) |
| Comorbidities |
arthritis, asthma, exercise induced asthma, edema |
| Policy |
Must be medically necessary |
| Comments |
The first letter was sent on Tuesday of this week....It's Friday and I called today and they promptly told me I'm approved and I have one year to use that approval. They were great!!!
Recommend: Put you height, weight, age, BMI, co-morbidities and very detailed diet history (should inlude one doctor supervised plan minimum of 3 months) (They're guidelines) in the letter to your doctor that he'll send with the request. |
| Source |
Kathy O |
| Insurer Policy |
Aetna (Managed Choice POS) |
| Insurer Status | Approved after first letter (11/6/01) |
| Surgery Type |
Open RNY - proximal |
| Weeks to approval |
3 |
| Comorbidities |
HBP, hypothyroidism, osteoarthritis of hips/knees/hands, panic anxiety attacks, depression, stress i |
| Policy |
Must be medically necessary |
| Comments |
10/11/01
I've been told that Aetna is great at approving WLS. I'll let you know (hopefully soon). My appointment with my surgeon was today, and I turned in all of my "homework" to his office staff for preparation of the insurance package. I am so nervous about getting approved. More later.
10/24/01
Talked to Tammy Lynn in Dr. Chua's office one week ago and she was getting my package ready for submission to Aetna...so Aetna should have my paperwork in house. Tammy said I could call her on 10/29 for an update. Please, please, please, God, let Aetna approve me for WLS. This waiting is horrible.
11/6/01
Tammy Lynn called me this morning -- I have been approved, and my surgery is scheduled for 12/26/01...Merry Christmas to Me! Aetna was easy to deal with. There was just a little mix-up at the outset. I called two weeks after the package was submitted by my surgeon to "check up" and no one could find my paperwork. After a quick call to Dr. Chua's office, and with the help of Tammy Lynn, my paperwork was faxed to Aetna and hand carried to the appropriate department. I was told that we/my surgeon could check on status in one week. Called today...told it was on the Medical Director's desk. Dr. Chua's office was notified one your later that I was approved. Not too bad. I thank my company for such a wonderful insurance program, I thank Dr. Chua and Tammy Lynn for the skill and expertise in preparing all of the paperwork, and I thank God for his blessing in this journey.
|
| Source |
Theresa P |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (11/29/01) |
| Surgery Type |
Open VBG |
| Weeks to approval |
2 |
| Pre-Op BMI |
40.6 |
| Policy |
Written exclusion policy |
| Comments |
I never had to deal with them at all, the Images staff told care of it all via the internet adn called me to tell me I was approved and scheduled the surgery for a week later!!! So far so good! |
| Source |
Jenny W |
| Insurer Policy |
Aetna (MPS Comprehensive) |
| Insurer Status | Approved after 2nd appeal letter (09/04/02) |
| Surgery Type |
Laparoscopic RNY - distal |
| Weeks to approval |
4 |
| Pre-Op BMI |
55.3 |
| MD-supervised programs |
2 (12 weeks) |
| Comorbidities |
arthritis, hypertension |
| Policy |
Must be medically necessary |
| Comments |
It was easy once I knew what they wanted. Aetna wants you to have at least 6 months of physican overseen weight loss. This means you can be on weight watchers but go to the doctor on a monthly basis to get weighted in and it will count toward that. Your doctor must make a note of the program you are on too. They also just don't accept a letter, they want clinical notes from your physicians. Yes I do think they respond to persistence. |
| Source |
Ifama J |
| Insurer Policy |
Aetna (NAP) |
| Insurer Status | Approved after first letter (04/19/02) |
| MD-supervised programs |
1 (4 weeks) |
| Source |
Ruth F |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (04/25/02) |
| Surgery Type |
Open RNY - proximal |
| MD-supervised programs |
3 (24 weeks) |
| Comorbidities |
no co morbibities |
| Policy |
Must be medically necessary |
| Comments |
Aetna was great. Everyone I talked with was helpful and tried to answer my questions. I really bugged them alot and they never got tired of me. Hava the nurse was very helpful and did everything that she could to get this done as fast as she could for me. Thank you Aetna for being so great. The approved in 24 hours after they got the request. My advise to anyone trying to get Aetna to approve is . One send everything (med records, letters from Docs, and other stuff) when the request goes in. And two bug them :) it worked for me. HA HA |
| Source |
Teressa D |
| Insurer Policy |
Aetna (QPOS) |
| Insurer Status | Approved after first letter (08/19/02) |
| Surgery Type |
Open VBG |
| Weeks to approval |
5 |
| MD-supervised programs |
4 (28 weeks) |
| Comments |
Aetna was not easy to deal with. They kept saying they hadn't received the LOMN or anything else.Fortunately I was working with the Compass/Images program. My patient rep pushed and pushed til it finally got into review. It was in review on 8/8, approved 8/19. |
| Source |
Helenjean P |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after appeal letter (12/30/02) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
52.3 |
| Comorbidities |
IBS |
| Policy |
Must be medically necessary |
| Comments |
Aetna requires weight history for the last 5 years and a doctor supervised diet of 6 month duration within the last 2 years. This all must be documented. I provided the weight history but had not been on a "doctor supervised" diet in the last 2 years. Though I was before that and have been on various diets within the last 2 years. They denied me for lack of information. I have requested an appeal because I'm told other people review the information. I have also started working with a nutritionist and if I have no results from the diet I will ask again for approval after 6 months. After I had the 6 months Dr. supervised diet, in which I managed to lose 1 pound, I reapplied for the surgery with another surgeon and was approved within a few days. |
| Source |
Kari W |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (08/15/02) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
3 |
| Policy |
Must be medically necessary |
| Comments |
I never had contact with them personally.
All paperwork was handled by and through my
surgeon's office.
|
| Source |
Cheri W |
| Insurer Policy |
Aetna (Options PPO) |
| Insurer Status | Approved after first letter (11/03/02) |
| Surgery Type |
Open Duodenal Switch |
| Pre-Op BMI |
50.5 |
| Policy |
Must be medically necessary |
| Comments |
My company policy is self-funded and once I sent a copy of the letter of medical necessity as well as the plan language indicating this was not an exclusion, I received a letter within days indicating that it was all approved. Very easy to deal with but you have to really read the UHC general guidelines to ensure if you qualify based on your BMI. |
| Source |
Debby L |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (11/17/02) |
| Surgery Type |
RNY |
| Weeks to approval |
5 |
| Comorbidities |
arthritis |
| Policy |
Must be medically necessary |
| Source |
Susan J |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after first letter (01/26/03) |
| MD-supervised programs |
2 (24 weeks) |
| Source |
Joanne L |
| Insurer Policy |
Aetna (Open Choice PPO) |
| Insurer Status | Approved after appeal letter (06/03) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
16 |
| Pre-Op BMI |
47.0 |
| Comorbidities |
Gerd, Diabetes, Hypertension, High Cholesterol, arthritis, asthma |
| Policy |
Don't know |
| Comments |
Aetna changed their policy in January of 2003. My PCP's nurse called several days before the policy change and I was immedeately denied the surgery just because we called. When they were sent all the info, they did not accept my diet attempts (because we used my blood sugars as a marker). I pestered to get a real name and spoke to the nurse who had my case and ultimately they decided that since the process had begun before the policy change I would be approved under the old policy. They responded to being bugged - but it was a pain in the you know what. They were quick about paying after the surgery. |
| Source |
Therevkck |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (07/08/03) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Comorbidities |
sleep apnea, arthritis, hypertension, diabetes. |
| Comments |
Just got the papers sent in today..time will tell..
I was sooo dreading Aetna even though I had done EVERYTHING they asked and it payed off..I was accepted in less than a week..
Thank God for Aetna.
|
| Source |
Kathy S |
| Insurer Policy |
Aetna (PPO open choice) |
| Insurer Status | Approved after appeal letter (03/07/03) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
53.2 |
| Source |
Mira E |
| Insurer Policy |
Aetna (epo) |
| Insurer Status | Approved after first letter (03/09/03) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
48.6 |
| Source |
Rebecca D |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (06/26/2003) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
42.9 |
| Comorbidities |
Urinary incontinence, High Cholesterol, Back pain and irregular periods. |
| Policy |
Must be medically necessary |
| Comments |
I didn't have to deal with them at all. Theresa from Dr. Weiland's office took care of everything. She got all of the information from different doctors and myself together and sent it in as one big packet. Approval took less than 2 weeks. They do not send out written but give a verbal and also a confirmation number. Theresa tripled checked to make sure they couldn't renege on this and they can't. |
| Source |
Barbara J |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after first letter (09/20/03) |
| Comorbidities |
arthritis |
| Policy |
Don't know |
| Source |
Carol K |
| Insurer Policy |
Aetna (N/A) |
| Insurer Status | Approved after 2nd appeal letter (08/30/05) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Comorbidities |
Hypertension, Joint problems, |
| Policy |
Must be medically necessary |
| Comments |
I originally apllied for a Lap Band surgery in 2004. I was denied because WPs did not beleive that it was necessary adn that I had not tried hard enough to lose weight. I tried again in September 2005 for a LAP RNY. I was approved after two weeks. |
| Source |
Kimberlyann C |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after appeal letter (02/12/04) |
| Surgery Type |
Laparoscopic RNY |
| Pre-Op BMI |
46.5 |
| Policy |
Must be medically necessary |
| Comments |
As of 4/19/04 i am postponed? need 3 months of supervision with a dietician. no fun. |
| Source |
Frankie L |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | First letter sent - still waiting (08-03-04) |
| Comments |
Extremely frustrating. I can't even find out where my paperwork is and yet they swear they have it. Some one once said to ask for the name and phone number of the person taking care of my paperwork/approval, I keep asking and never get an answer.
My paperwork was mailed from my dr's office on August 3rd. Aetna recieved it in their system on August 10th and now it is Medical Review but they will not tell me with whom. UUUUHHHHHGGGGGGGG!! |
| Source |
Renee B |
| Insurer Policy |
Aetna (Group) |
| Insurer Status | Approved after 2nd appeal letter (05/24/04) |
| Surgery Type |
Open RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
46.8 |
| Comorbidities |
Sleep apnea, AF, hypertension |
| Policy |
Must be medically necessary |
| Comments |
Dealing with the insurance company was the hardest part of the whole process. After being denied a second time someone at the insurance company told me to contact the benefits personnel at my company. This is when I found out we were self-insured. After the benefits office finally read all the information from my primary doctor, cardiologist, and Dr. Tom; they approved the surgery at 100%. |
| Source |
William P |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after appeal letter (07/01/04) |
| Source |
Andrea M |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (07/06/04) |
| Weeks to approval |
3 |
| Comorbidities |
PCOS |
| Policy |
Must be medically necessary |
| Comments |
I didn't have to deal with the insurance company at all. I knew they needed a 6 month supervised dietician attempt.
I was approved 3 weeks after it was sent for approval. |
| Source |
Kim P |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (07/17/04) |
| Surgery Type |
Open RNY |
| Pre-Op BMI |
54.1 |
| MD-supervised programs |
1 (16 weeks) |
| Source |
Michele K |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after appeal letter (07/28/04) |
| Weeks to approval |
62 |
| Comorbidities |
Congestive Heart Failure, Left Bundly Branch Block |
| Policy |
Must be medically necessary |
| Comments |
Dealing with them is very difficult. It seemed to me they are very disorganized and hard to get a straight answer from. For example: I sent my appeal letter to the address given in my denial letter and I got it back saying there was no such address! I then called the 800 number and had a 4 way conference call with 4 different places and I got three different address where I should mail my appeal! I got very angry and told them how frustrated I was and they gave me a number to call to be sure they got my appeal and also a FAX number where i could also FAX it. Once it got to the right place, they responded with a follow-up letter saying they received my appeal and they would respond via mail within 15 days with a decision. THEY DID! You need to be persistent. |
| Source |
Lois H |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (02/2006) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
44.6 |
| MD-supervised programs |
3 (34 weeks) |
| Comorbidities |
osteoarthritis, insulin resistance, high blood pressure, stress incontinence, depression |
| Policy |
Written exclusion policy |
| Source |
Ms D |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (11/04/04) |
| Surgery Type |
Open RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
52.5 |
| Comorbidities |
Sleep Apnea Joint Pain |
| Policy |
Must be medically necessary |
| Comments |
It seemed hard because they just didn't listen until I got my Benefits Manager involved and it was approved within 2 days.
Insurance companies do stall unless you get on the phone with them.
Yes
Make sure that you have all your paperwork and information in order. Be firm when you know you meet the qualifications.
|
| Source |
Lori B |
| Insurer Policy |
Aetna (Core plus PPO) |
| Insurer Status | (11/08/04) |
| Surgery Type |
Laparoscopic RNY |
| Policy |
Written exclusion policy |
| Comments |
Aetna has a policy citing medical necessity. It looks to be pretty understanding. My particular policy, may have a written exclusion. Since my policy doesn't become effective until 1/1/05, I will not know until I receive my paperwork. I did have my Human Resources Coordinator call and check, she was told there is a specific exclusion. |
| Source |
Shari C |
| Insurer Policy |
Aetna |
| Insurer Status | First letter sent - still waiting (01/06/05) |
| Source |
Nancy N |
| Insurer Policy |
Aetna |
| Insurer Status | Denied after first letter (01/08/05) |
| MD-supervised programs |
2 (52 weeks) |
| Comorbidities |
urinary incontinance, varicosities,diabetes, bmi of over 40, constant heartburn,high cholesteral |
| Policy |
Don't know |
| Comments |
the nurses dealt with them, told me I was denied, I gave up and never went back till now, I really need to do this, there is no other way. Fat has been my life, not just my adult life. I have tried emailing aetna, got no response, tried calling and get the automated. |
| Source |
Carol V |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after 2nd appeal letter (01/12/05) |
| Source |
Brenda H |
| Insurer Policy |
Aetna (mps comprehenssive ppo) |
| Insurer Status | Approved after appeal letter (02/06/05) |
| Surgery Type |
Laparoscopic Fobi Pouch Gastric Bypass |
| Weeks to approval |
30 |
| Pre-Op BMI |
47.3 |
| MD-supervised programs |
4 (32 weeks) |
| Comorbidities |
depression, high blood pressure, incontinence, arthritis, irregular menstration |
| Policy |
Must be medically necessary |
| Source |
Jodi B |
| Insurer Policy |
Aetna (ppo) |
| Insurer Status | Approved after appeal letter (02/20/05) |
| Surgery Type |
Laparoscopic Lap Band |
| Pre-Op BMI |
38.8 |
| Policy |
Must be medically necessary |
| Source |
Cynthia L |
| Insurer Policy |
Aetna (PPO) |
| Insurer Status | Approved after first letter (03/06/05) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
42.5 |
| Comorbidities |
Sleep Apnea/Arthritis/Hypertension/Diabetis |
| Policy |
Must be medically necessary |
| Comments |
So far it has been very easy dealing with Aetna. It has only been a week and they have already contacted my doctor's office and let them know what additional information is needed. I am fortunate that my doctor's office is so organized and responds so quickly. 9/13/05 - Was approved for surgery in 1 week. |
| Source |
Melanie Y |
| Insurer Policy |
Aetna (Open Choice PPO) |
| Insurer Status | Approved after first letter (04/25/05) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Pre-Op BMI |
44.8 |
| Comorbidities |
High blood pressure, GERD, degenerative joint disease |
| Policy |
Must be medically necessary |
| Comments |
4/21/05- my file was submitted to Aetna
4/22/05 (Friday)- Within one day Aetna contacted the nurse to let her know that my past weight history was incomplete and that they were going to deny my surgery. Luckily, she talked them into leaving my claim open until Monday so that we could get the missing pages, (from 2001-2003) from my PCP. They were faxed within an hour or two. I'm praying and keeping my fingers crossed.
4/22-4/25 I'm a nervous wreck. What if Aetna still finds something wrong? I'll be a very broken woman if Aetna doesn't approve this.
4/25.... YIPPPEEEE!!!! WOW! I cannot believe how fast that process occurred! I was approved today. They received the fax on Thursday, cleared up some info. on Friday and I was approved by Monday a.m. I am so relieved. I can't wait for my new life to begin!
I highly recommend working with a team that knows Aetna's ins and outs. They have many necessary and required documentation for approval. If you know what you need to submit, the process goes squeeky clean and very fast. |
| Source |
Katie B |
| Insurer Policy |
Aetna (Aetna) |
| Insurer Status | Approved after 2nd appeal letter (04/30/05) |
| Source |
Bernard C |
| Insurer Policy |
AETNA |
| Insurer Status | Denied after first letter (07/08/05) |
| Source |
Chocolatecovered C |
| Insurer Policy |
AETNA (PPO) |
| Insurer Status | Approved after first letter (2/11/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
1 |
| Policy |
Must be medically necessary |
| Comments |
I really have to say that at this point, I have not had any problems dealing with my insurance company. I followed the directions of my surgeon insurance furu and it was really easy. I was nervous and setting my self up for the denial but just less than 1 week from submittal I was approved. my advice, listen to what they tell you and follow it to the letter. Make sure that your physcian notes are very detailed and always start talking about obesity. Thank you so my Keri and Aetna!! |
| Source |
Jeanna S |
| Insurer Policy |
Aetna (POS) |
| Insurer Status | First letter sent - still waiting (09/29/05) |
| Comorbidities |
Hypertension, Gerd |
| Policy |
Must be medically necessary |
| Source |
Barbara A |
| Insurer Policy |
AETNA |
| Insurer Status | Approved after first letter (10/11/05) |
| Source |
Carolyn B |
| Insurer Policy |
Aetna (POS Managed Care) |
| Insurer Status | Approved after appeal letter (10/05/2006) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Comorbidities |
Depression, Hypercholesterolemia, Hypertension, Shortness of breath, hypothyroidism |
| Policy |
Must be medically necessary |
| Source |
Peggy T |
| Insurer Policy |
Aetna (Aetna Select) |
| Insurer Status | Approved after first letter (5/08/06) |
| Surgery Type |
Laparoscopic RNY |
| Weeks to approval |
2 |
| Pre-Op BMI |
41.6 |
| Comorbidities |
Diabetes, Hypercholesterolemia |
| Policy |
Must be medically necessary |
| Comments |
I had started this process nearly 2 years ago, with a different insurer, and was denied due to their change in policy requiring 12 months of physician-supervised dieting prior to consideration for surgery. So, I was understandably nervous when submitting to Aetna. I was SUPER compulsive about making sure that the surgeon's office had everything they needed before submitting. Once it was submitted, though, I called every other day to the insurance company to check on the status. I think it helped, because it seemed that the information was being moved along the approval trail each time I called. They were very friendly and helpful, and never seemed annoyed that I kept calling. I was always very polite, and if I didn't get an answer, they always encouraged me to check back in a day or two.
Once the approval was granted, a nurse from the insurance company called to make sure I understood the surgery, did I have any final questions, was I aware of the physical restrictions afterwards, etc? I was really appreciate of this. It didn't feel like they were looking for a way to pull back the approval. It just seemed like they had my best interests in mind, and wanted to be sure I was prepared to undergo major surgery. The nurse provided the number for their 24 hour information line, just in case I had any questions the night before surgery (or after). The line is staffed by nurses, so if I had a general question, and didn't want to call my surgeon, someone was available to answer it. The nurse also called back 4-5 days after surgery, just to check in with me. It was a smooth, very nice process, and I always felt like they believed (like me) that this was a positive step towards better health (rather than just another large expense for the insurer). |
| Source |
D K |
| Insurer Policy |
Aetna |
| Insurer Status | Approved after first letter (06/18/06) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Hypertension, Chronic skin conditions, Depression, Hypercholesterolemia, Stress incontinence |
| Source |
Jenny O |
| Insurer Policy |
Aetna (Managed Care) |
| Insurer Status | Approved after first letter (06/29/06) |
| Surgery Type |
Laparoscopic RNY |
| Comorbidities |
Hypertension, Hypercholesterolemia |
| Source |
Lori W |
