Question:
Aetna approval since Jan. '03
Has anyone been approves from Aetna since January 1, 2003. If so, how long did they take to approve WLS. I am aware of the new guidelines they have in place for WLS approval. Please advise on your experience with Aetna if you have been approved in '03. Thank you all. — Shayla527 (posted on April 29, 2003)
April 29, 2003
In March 2003, from the time my Doc's office submitted the paperwork (which
took them 3 weeks to do), it was approved by Aetna in 4 days.
— [Deactivated Member]
April 29, 2003
I had surgery on Feb. 11, 2003. I'm 11 weeks post op and 53 pounds less and
over 30 inches gone. I'm 5'4" and was at 250 when this wonderful
journey began for me. I feel great!
Aetna made it's approval in less than a 24 hours.
Good Luck and fell free to e-mail me.
— Hazel S.
April 29, 2003
I have Aetna and was approved in early January '03, and had my surgery
February 5, 2003. They have tightened their criteria, but fortunately, I
met their requirements. It was a few weeks after we applied - they asked
for a bit more information (5 years worth of medical records), but once
they had that, they approved immediately. Even so, it was a huge anxiety
waiting...
— johanniter
April 29, 2003
I have Aetna. I was denied in Dec 02, I appealed Jan 03, was approved Feb
03 and had surgery Mar 12, 2003. Initially my doctor just sent them the
basics. Upon my denial I began to really work on my appeal. I gathered
letters from: Old PCP, Current PCP & Surgeon. In order to be a HUMAN
to them I included a letter from myself with pictures since the day I was
born. I also had my best friend who also had the surgery write a letter.
Test results: Both ols and new. Made a chart of: Diet History & Family
History. I think I was approved within 1 week and 1/2. Good Luck!
— Dayanara A.
April 29, 2003
I understand that Aetna's "additional criteria" was just passed
on 3/23/03. It is affecting me also - I feel like I am going thru hoops to
get what they want and may have to wait a year to be able to provide the
documentation they are asking for. I am seriously considering taking a
loan out to pay for the surgery myself! Any help or samples of letters
sent to Aetna from PCP, etc since 3/03 would be appreciated.
— Nannette
April 29, 2003
Nannette - Aetna revised Coverage Policy Bulletin #157
(http://www.aetna.com/cpb/data/CPBA0157.html) was posted 1/17/03. From
what I heard, it was in effect even before it was posted - even as early as
the latter part of 2002. My wife was approved for WLS in February
(surgery date is next Tuesday) without the physician-supervised diet -
however, the PCP supplied several years of her charts documenting my wife
weight problems and her increasing dosages of diabetes medications over
that time period. Apparently, we got a sympathetic reviewer. All I can
say is to gather and provide as much documentation as you can - doctor's
charts, your own diet history, letters from other specialists if you have
seen them, etc. It is possible to get approved without meeting those
guidelines 100%, but you have to build a good case for it. You can't just
go in with minimal documentation and hope to get approved anymore...JR
— John Rushton
April 29, 2003
took 1 week for me to be approved by Aetna, I got my approval 2 weeks ago
friday, my surgery is May 27, 2003.
Good Luck!
— hugzprn
April 29, 2003
Please go to my site here. I posted the entire letter from the external
reviewer who overturned Aetna's denial. Aenta never saw any of my medical
records! I am now approved with WLS on June 10th! Keep pushing!
— toni S.
April 29, 2003
I was approved in 3 weeks. My doctor sent in the paperwork the begining of
March and my surgery was April 7th. I did not have documented physician
supervised diets since I haven't been to a doctor in approximately 20
years. My new doctor (7 weeks) wrote a letter and I was approved. I love
Aetna!!
— Frank A.
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