Seeking Aetna approval

Okay, I have a question. My insurance is Aetna and I live in PA, I have a BMI currently of 53 and I am 5'5" tall and am considering having the lapband. I am just about finish with all of my pre op testing/clearances. I was told by my surgeons office that Aetna would not approve me for the lapband unless I had a BMI in the low to mid 40's, has anyone else been told this? Also, my surgeon has a 300 lb weight restriction on those that he performs the surgery on.

I have Aetna as well. What I can tell you is Aetna is a stickler for paperwork. If you do not have what they are asking for then they will deny you. As for the BMI question there is nothing listed in there policy about a BMI that is to high. They do however require a supervised diet. There is two different options either a 6 month or a 3 month. They are outlined in the policy.

As for you surgeon having the 300 lbs limit I think is bogus. You might consider changing surgeons.

Yes, I printed off the entire policy bulletin and I didn't see anything in there about a BMI weight requirement to have the lapband. I am going to call them today to make sure. The 300 lb. weight restriction by my surgeon is ok with me, because I know that is in my best interest, I can lose the few pounds to get me there, I was just concerned about the pounds to get my BMI down in the 40's. Thanks for responding!

I have atena also and I go to see my surgeon office for the fist time next week. Im a littl concern about all that myself. As far as the BMI and weigh thing, well my boyfriend is goin to have surgery also and the surgeon he was going to had a weigh limit also, it was 400lb. So I think the BMI and Weight requirment is specific to the surgeon you see.  Also to was that the restriction for just the Lapband or for any of the surgeries

Yes, I have heard how difficult Aetna can be, but I am not worried about getting the approval for WLS because I know that I would qualify. Now, what does concern me is if they will approve me for the lapband. I just have to trust God to take care of all of that stuff. Now for my surgeon, no he has the weight restriction for all the surgeries he does, lapband or RNY. I pray all goes well with you and your approval.

Be worried about getting approval for WLS.  I to have Aetna and was denied.  I also have all the criteria for the surgery but was denied.  Like one of the post said, Aetna is a stickler for paper work.  They denied me because I did not show proof of the supervised diet.  I have a BMI of 42, sleep apnea, borderline high blood pressure, lower back pain all which should be enough for approving me for the surgery but I was denied because my PCP failed to documentation my paper work.  Aetna wants every thing listed in their policy and I’m here to tell you if you are missing anything, they will not approve you for surgery. Most of us have all the medical reason for having the surgery. If you are not doing a MEDICIALLY SUPERVISED DIET for 6 or 3 months they WILL deny you.  I started this process back in December got denied and now have one month left on my supervised diet and they I have to appeal their decision and pray they will approve me.  Make sure you read and follow their requirements and you’ll get approve.

Yes, I did hear about Aetna and I am almost ready to forward all of my info to them. I really am not going to worry about the approval even though I know that I qualify, but if they don't approve me, then I have to realize that it is not meant to be at this time, but I will do what I need to do in order for me to get approval. Thanks so much for responding to this post and I pray that all will go well with you in your approval process.

No, he's wrong. Aetna doesn't require a BMI in the low to mid 40's for lapband. They have the exact same requirements for lapband or RNY or DS. Once they approve it, they leave it to you and your surgeon to choose what's best for you.  It sounds like your surgeon has a preference for that. But he's mistaken about Aetna not approving it.

Aetna IS a stickler about a lot of other things, but not that.