Has anyone covered by the State of Alaska's AlaskaCare Insurance program had trouble getting approval for gastric bypass surgery from the State's claims administrator, Aetna HealthCare, in Washington? It appears that the claims staff for Aetna HealthCare may have been using an inappropriate policy and criteria for adjudicating AlaskaCare requests for surgery for the last several months. From what I've been able to discover talking with a number of people, the claims people for Aetna HealthCare have been using criteria that applies to people who actually purchase their insurance from Aetna. When ruling on a request by an AlaskaCare participant (Supervisory, Retiree, etc), the claims staff is suppose to use the criteria outlined in the State's Group Insurance Information Handbook. If you or someone you know covered by one of the AlaskaCare programs has had a problem with Aetna approving a request for surgery, you may want to contact either the Division of Retirement and Benefits, your bargaining unit representative, your legislator, and/or your doctor's office. Ask them to make sure that Aetna HealthCare is using the proper criteria in your case, Only the requirements listed in the AlaskaCare health plan book should be used. I would like to hear about the experiences others have had with obtaining AlaskaCare approval. I am expecting that I will still have to file an appeal to get the proper approval for my surgery. The experiences of others might give me inspiration and encouragement. Good Luck to you all.

Has anyone else had a recent problem obtaining approval ffrom the State of Alaska's AlaskaCare insurance program for their gastric bypass surgery? I discovered earlier this week that the state's administrator for the AlaskaCare program, Aetna HealthCare of Washing, may have been using the wrong criteria to adjudicate claims since January. On January 17, Aetna issued a Coverage Policy Bulletin which cited an expanded set of requirements that had to be met before the surgery would be approved. However, that Coverage Policy Bulletin applies only to people covered by an insurance policy purchased from Aetna. The State of Alaska is self insured and has its own, unique selection criteria for the surgery. Only the requirements listed in the State of Alaska Group Insurance Information Booklet should be used to adjudicate a claim for AlaskaCare participants -- including retirees! If you and your surgeon have been forced by the Aetna claims people to jump through a lot of needess hoops recently to gain approval for your surgery and you are insured through the State of Alaska AlaskaCare program, you may want to contact Retirement and Benefits ASAP. I'd like to hear about the experiences of others. I suspect I will still have to file one or more appeals before my surgery is approved even thought I have a 20 year medically documented struggle with weight. Good luck to you all. LeRoyAK