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Topic: RE: How long for Aetna's insurance decision?
Thanks so much for your reply - and your encourangement!! I am excited and scared, but mostly excited! I am so ready to live again - to be healthy and active!
It will be a week on Monday, so it is very early.
Sounds like you have a ton of experience with Aetna and you have obviously been a great success!! Congrats!!!
Glad to be your friend!!
Angie
It will be a week on Monday, so it is very early.
Sounds like you have a ton of experience with Aetna and you have obviously been a great success!! Congrats!!!
Glad to be your friend!!
Angie
Topic: RE: How long for Aetna's insurance decision?
Hi,
I have Aetna as well as my three children. All four of us have had bariatric surgery. Three of us did the 3 mo MD program and my one son did the 6 month program (only because he needed to buy time since he wasn't 18 yet) Two of us were denied at first and my two sons were approved right away.
With the approvals of my two sons, from the time it was submitted, it took about two weeks to hear back that they had been approved.
I was at first denied only because my paperwork was turned in too soon and I had not gone to my final physician visit. so as soon as I completed the program, I appealed and it took about 3 weeks for them to overturn the denial.
My daughter was also denied after going through the 3 month MD program. I filed an appeal for her, and it took 27 days to hear back that the denial was overturned and she had been approved.
A word of caution...don't be discouraged IF you are denied. I can help you with an appeal as I have had a lot of experience with Aetna and what the require with all four of us going through this. They are very picky about meeting the requirments, but as long as you have done everything required of you, they will approve.
Did you see your PCP, a dietician, document behavior modification and exercise with your PCP, meet the requirements of the BMI, and submit your psych eval? If so, you will have no trouble getting approved.
I had my surgery in March 2009, my daughter in May 2010, and my two sons in Dec 2010.
Good Luck to you!
Nan
I have Aetna as well as my three children. All four of us have had bariatric surgery. Three of us did the 3 mo MD program and my one son did the 6 month program (only because he needed to buy time since he wasn't 18 yet) Two of us were denied at first and my two sons were approved right away.
With the approvals of my two sons, from the time it was submitted, it took about two weeks to hear back that they had been approved.
I was at first denied only because my paperwork was turned in too soon and I had not gone to my final physician visit. so as soon as I completed the program, I appealed and it took about 3 weeks for them to overturn the denial.
My daughter was also denied after going through the 3 month MD program. I filed an appeal for her, and it took 27 days to hear back that the denial was overturned and she had been approved.
A word of caution...don't be discouraged IF you are denied. I can help you with an appeal as I have had a lot of experience with Aetna and what the require with all four of us going through this. They are very picky about meeting the requirments, but as long as you have done everything required of you, they will approve.
Did you see your PCP, a dietician, document behavior modification and exercise with your PCP, meet the requirements of the BMI, and submit your psych eval? If so, you will have no trouble getting approved.
I had my surgery in March 2009, my daughter in May 2010, and my two sons in Dec 2010.
Good Luck to you!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: Cash Pay
While I didn't have any complications to test it out, I was told that no complications would be covered. It made me wonder what could be tied as a complication and for how long, say 5 years down the road I have a hernia, will they try to blame it on this, etc. That was my biggest fear but to date hasn't been tested.
Topic: medicare medicaid plus pay aftercare self pay in cash preop?
I am medicare medicaid and they will cover R and Y by my understanding . I meet the doctor this week.
However, I was just talking to my neighbor who had medicare also but he had to pay Dr GastricBypasser $3000 upfront before he'd agree to operate ....not to leave a deposit on medicare or the like - but as a token of his sincerity about attending the aftercare program that is a support group, exercise, dietary ... yada yada. Which he'd have to pay anyway so said the doctor.
This set off warning flags in my mind. Is this reasonable to expect
However, I was just talking to my neighbor who had medicare also but he had to pay Dr GastricBypasser $3000 upfront before he'd agree to operate ....not to leave a deposit on medicare or the like - but as a token of his sincerity about attending the aftercare program that is a support group, exercise, dietary ... yada yada. Which he'd have to pay anyway so said the doctor.
This set off warning flags in my mind. Is this reasonable to expect
Topic: How long for Aetna's insurance decision?
I have Aetna.... Anyone have any idea how long it takes after submission for Aetna to make a decision?
AND I did the the 3 month "Fast Track" ... Anyone started with this and Aetna required them to go the extra 3 months?
If so, what was your final outcome?
Thanks so much in advance.
AND I did the the 3 month "Fast Track" ... Anyone started with this and Aetna required them to go the extra 3 months?
If so, what was your final outcome?
Thanks so much in advance.
Topic: Medicaid (repost from main board)
I have Tricare Prime now but will be without insurance starting August 23. I dont have enough time to get surgery thru Tricare. I was wondering how hard is it to get Medicaid after my Tricare runs out? Is it hard to get WLS done thru Medicaid? What is involved for getting WLS approved thru Medicaid. Thanks
Topic: RE: United health care choice plus???
HW: 333, SW : 300 CW: 275. GW; 150
That is my understanding too. I also have UHC and was advised by the patient advocate at my surgeon's office to contact HR rep to determine if they bought the WLS portion of the plan. Found out they did. Couldn't give me much details about it, but at least I now know it is covered. I'm also in the very early stages of this process, still don't know if I will need the supervised diet. Good Luck. Hope that helps some.
HW: 333, SW : 300 CW: 275. GW; 150
Topic: WLS referred to as Cosmetic?
I am posting this in the cosmetic forum also, but I figured I would post here too. I have Anthem BCBS, almost 6 years out from lap RNY, lost 150 and have maintained.
I am currently seeking a corrective/reduction surgery for my breasts. My PS submitted my preauthorization claim to my insurance (requesting mastopexy) and they came back with the correction/reduction is the result of a previous cosmetic surgery and that they will not cover it. I have appealed and they have stuck to their decision. I meet the requirements for reduction with documented neck and back pain over the past 2 years and hand problems.
I understand that some people seek WLS as a cosmetic self-pay procedure but mine was considered elective medically necessary and covered by my insurance (Tricare) at the time. My current insurance also covers WLS as the only method to treat obesity. And I would have met their requirements to have the surgery. How is it that they determined that it was a cosmetic procedure?
I am currently seeking a corrective/reduction surgery for my breasts. My PS submitted my preauthorization claim to my insurance (requesting mastopexy) and they came back with the correction/reduction is the result of a previous cosmetic surgery and that they will not cover it. I have appealed and they have stuck to their decision. I meet the requirements for reduction with documented neck and back pain over the past 2 years and hand problems.
I understand that some people seek WLS as a cosmetic self-pay procedure but mine was considered elective medically necessary and covered by my insurance (Tricare) at the time. My current insurance also covers WLS as the only method to treat obesity. And I would have met their requirements to have the surgery. How is it that they determined that it was a cosmetic procedure?
Topic: RE: United health care choice plus???
I'm certainly no expert but I'll tell you my experience. I had BCBS before UHC. 5 years ago I started the entire process and was told 6 months monitored weight loss or 3 months of 2. That made no sense to me. So, I went to ww and my Dr. at least once a month. They turned me down saying my Dr. wasn't an approved monitored weight loss. What??? I think they just wanted to say no, no matter what. Then I had a tragedy in my family and put off the whole process. Move ahead 5 years and my insurance changes. I thought I'd just check out and see what UHC will cover. Gave them a call and they told me it was covered and she did not see that I would have to do the 6 month monitored weight loss program. So, I just decided to do what my Dr. required and have them submit it and see what happened. If I need to do the monitored weight loss I would start. It was very simple for me because I got approved the first time without having to do the 6 month weight loss program. I know it's a frustrating process because you get so many conflicting answers. In my case, I wanted them to submit it and go from there. I know this probably doesn't help much but this is where I've been. If you have your Dr. submit for approval and you get denied because you need to do the 6 months, is it harder because you have to appeal? I don't know. Good luck and let me know what happens.
Topic: Aetna - appeals committee
I have been denied by Aetna for VSG. First because they stated I didn't meet the criteria of weightloss. However, I appealed and proved that I do meed the medical criteria however, they came back with a second denial because they say that I didn't meet psych clearance. Which was untrue. I faxed in the pysch clearance but now they want to do a Level II appeal committee tele - conference. I can choose to phone in and state my case to an unknown board I will be given 15 minutes to do this. Then I will be asked to leave the call where they will deliberate without me and send me a letter with their decision within 5 business days. They also state that I can have a lawyer present it I want to. WTF. Does anybody have any experience with this? What should I expect?
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