Does anyone know their requierements for surgery approval??

Hello,

I have Aetna PPO and myself and all three of my kids were approved for surgery.  Yes, there are hoops to go through but not much different than any other insurance.  If you go to Aetna.com and in their search engine type in 0157 it will bring up their clinical bulletin of the reqirements needed to qualify for bariatric surgery. 

Basically, you need to do a 6 month physician supervised diet or a 3 month multidisciplinary program (one or the other).  Three of us did the 3 mo MD program and my one sone did the 6 month plan.  YOu have to prove being morbidly obese for the past 2 years (meaning a BMI of .40 with no co-morbidies, or a BMI of >35 with at least 2 documented co-morbidies)

If you meet the requirements and are going to pursue, let me know and i can send you some stuff on how to go about doint the 3 month program as I have shared it with others on this site.  Like I said, myself and all three of my kids have had surgery.  Two of us were denied at first and I needed to appeal, but won the appeal so I have a lot of experience and knowledge of what type of documentation is needed for approval by Aetna.

Hope this helps.

Nan

Has anyone been approved in the last 6 months with BCBS NJ?  I'm looking for the new guidelines, whether there is a supervised diet still in the policy.  If you have been, how long did it take?  What kind of documentation do I need for non-surgical weight loss programs...  Thanks for the help!

I wanted to share the link to our latest blog describing another Aetna denial (lack of a 2 year history of morbid obesity) which we got overturned....hopefully it helps someone needing it!
wlsappeals.com/winning-bariatric-surgery-insurance-appeals/

Well I just need information.  I have been fighting an exclusion on my policy.  I have submitted letters from all my doctors along with my personal letter. In addition my employer also requested that they lift and or set aside exclusion to allow me to have this surgery upon medical need.  Last Friday I went in person to get an answer from BC/BS.  I was informed that it was denied. Now I want to appeal decsion and since I am doing this on my own, I need any input you all could give me.  It is like I told them that you now cover my eyes and it is excluded but you cover now cause I am a diabetic.  This is same princpal here, I am very frustrated in the play on words that they use to deter you from appealing etc... I have been working on this and it is imperative I get this procedure done. My doctors tell me that I will lose the use of insulin and since I am insulin resistant.  I am on this huge ****tail of insulins to just keep it in check.  I could go on and on with issues. Any advise on my approach from here and how I may get this accomplished it would be greatly appreciated.