Question:
Does anyone have Aetna and how tough are they for approvals?
Two years ago when I considered wls I heard that my insurance was the worst when it came to approvals. It made me really nervous so that was one reason why I didn't go through with it. Does anyone know anything about them? Hopefully there are some positive stories. — [Deactivated Member] (posted on March 18, 2009)
March 18, 2009
I have Aetna but it all depends on what your Employer agreed to w/Aetna.
With me, Aetna required all of the following before they would even
consider approving me for Lap/RNY, they ask that I saw a Nutritionist for 3
months, a Pulmonary Doctor, one time visit to a Psych, Cardiologist and
that my primary care physician provide a history of my unsuccessful weight
loss. I have a friend who also has Aetna but different Employers, &
they approved her way before she started this process so it all depends. I
had to get a "Clearance Letter" from my Primary Care Physician
and my Cardiologist and then the others had to submit their records. The
entire process took me 9 months from beginning to end. I hope this helps.
— Ruth M.
March 18, 2009
I have Aetna insurance and I had started my process in 12/07. Submitted it
the first week in January and was denied because I did not meet their prior
dieting history. So I went on a multi-disciplinary regimen with my
surgeon, dietitian and physical therapist for 3 months. Resubmitted in
April and again was denied. They wanted to see a minimum of a 6 month
physician monitored diet program. So I went to my PCP and told him my
dilemma and he really wanted me to have the surgery, so we set up monthly
appointments where I would go in and get weighed and I provided him food
diaries on everything I was eating along with a signed letter from my Gym
on what classes I was attending. We resubmitted in July (not quite 6
months but they must've counted the prior 3 months with the surgeon and the
dietitian) because I got approved!! I had Lap RNY on September 22, 2008.
If you call them and ask them specifically what they want, they will give
you the information and you need to follow it to a T so that it is
approved. It was the best thing I ever did. And they paid for
EVERYTHING!!!
— Brenda S.
March 18, 2009
I have Aetna and my surgeons office contacted them after my seminar. They
found out exactly what was needed and after all of it was completed I was
submitted to insurance. It took them less than one day to approve since I
had all my "ducks" in their rows. Just make sure to find out what
they want before they submit for approval. It will all be worth it in the
long run. Good luck. Paula
— Paula K.
March 18, 2009
I also have Aetna, and on their website, they pretty clearly state hat they
require for basic approval. Of course, it does depend on the employer as
well, but basicaly they require 6 months of CONSECUTIVE physician-assisted
weightloss which must be the primary reason for your visits, visits
documented. I needed a letter of recommendation from my PCP, and
documentation of all of my co-morbidities. I then had to pass evaluations
from psych, nutritionist, and physical, all of which were provided by my
surgeons office. Once everything was cleared and all documewnts were put
together, they were submitted and I am now waiting for Aetna to approve me.
My surgeon's office typically takes care of submitting all paperwork, and
they tell me that mine is an "open and shut case", so we are all
anticipating a speedy approval.
— stellarsan
March 19, 2009
Aetna is fine as long as you get the guidelines from them and follow it.
Begin the process, it can take a year or a little more but it is worth it.
— trible
March 19, 2009
Like all the other posts, I too was approved by Aetna. I also have HMO, so
I figured my request would be denied. But, because my 'ducks' were also in
a row - I was approved within 3 months and even able to bypass some of the
requirements because I was in such bad health. There were two things I
think contributed to my expediant approval. I am a record keeper and had
more than 10 years of receipts of every weight loss endeavor I attempted. I
searched through every box, drawer, closet, file, etc. to pull together
those records and it took me a whole weekend to organize them and create my
report. From Weight Watchers at least 5 times, Jenny Craig, Quick Weight
Loss, etc. to including every doctor visit reciept that was a result of my
being overweight; bone spurs, stress fractures, sleep apnea, pulmonary
edema, borderline diabetic, hypothyroidism, etc. I put it all on one
peice of paper in chronological order and included my weight, cost, losses,
gains. I put all the receipts in a bag with the piece of paper. They did
not even look at my reciepts. The 2nd factor is my doctor. He wrote a
personal, eye opening letter of my history with him and his concern of the
quality of life/life expectancy I would experience if I did not get rid of
the excessive weight. He even stated he did not approve of the surgery,
but thought it was the only alternative since he was aware of my
experiences in trying to lose weight through the 4 years he knew me. My
surgery was in August, 2007 and I have lost 100 lbs. - not as much as some,
but ALL my health problems except Hypothyroidism have disappeared & I
feel great. My thing - It took a lot of sacrifice to prepare for the
approval process, but it was all worth it. If it involves your health and
is not for cosmetic purposes, you should probably be approved!
— BonnieP
March 19, 2009
i had surgery 28 months ago -- had/have aetna -- i was approved in 2 weeks
-- i did every thing they said to do -- i had every test --- did the 6
month diet blah blah blah -- 2 weeks -- i thought that would have been
normal mail/fax, read, sit on desk, approve time :) not a complaint at all
about aetna -- it was all good :)
— RCassety
March 19, 2009
aetna was great. I had to see a phyc a few times, see the diatician for 3
months. They got my medical background from my pcp and I was approved
pretty quick. Within a couple of weeks. I had my surgery March 27, 2008 Dr.
Michael Green Plaza Medical Center. I started at 306 lbs. size 26/28 and
almost 1 year later I'm down to 160 lbs. size 8/10. best thing I ever did
for myself!!!!!
— Theresa Blodgett
Click Here to Return