First Post: Atena BC/BS Approval Process

Hello CA Message Board-
First of all I am so inspired by all of you. After months of consideration I decided to move forward and get the lap band. At 260 lbs (my BMI is 40)I feel like small fries in the doctors office which is why I am anxious, secondly I have no severe medical conditions.

After doing some research I have selected a surgeon. Attended a seminar, had a consult then the games began. I have since seen a Psy, nut., cardio, had a UGI. Now it is time for submission to my insurance....

I am getting anxious.... Do I have a chance??? How long does the approval take?

I don't know what Atena requires but I wanted to say good luck and you have come to the right place.  If you have any question please feel free to ask.  I get so much support on this forum.  I just love everyone here!

Welcome to the Cali board, we're so glad you've joined us.  I can't speak about the approval process but I'll bet your surgeon's office could tell you if you do. They do this all the time and they have a good idea of who will and who won't.  Hang in there and take it one day at a time.

Again, welcome so glad we can share the journey with you, it's a wild ride!

Hugs,
Barb

The first thing you need to find out is if your insurance even covers lap band.  Alot of them only cover RNY.  Now that doesn't mean you can't get the type you want, you just have to fight for it.  But it also means that it must be proved that first off you medically require WLS and that one specific type is safer/better for you than another type.  The approval process can get quite frustrating for many people at times.

In your case, with a BMI of 40 you are right at that approval point.  Most insurance will approve WLS with a BMI of 40 and above with no co-morbidities and below 40 with co-morbids.  Again, you need to check out what your insurance requirements are.  If you have already seen a surgeon, I would hope that they know what your insurance requires prior to submitting everything.

So, do your homework.  Research all the types of WLS and continue asking your questions.  Good luck.

Stephanie

I dont have any good news for you but I did want to say welcome to the board.

go to aetnas web site and look up their policy,.It is spelled out there in black and white for you.