Hello,

I have HAP insurance through my husband’s job and I have been trying to get approved for surgery for at least 6 months.  In that time I have gotten three different denial letters for this procedure.  First time it was because I didn’t have enough information for them to review, so I sent them the information they were asking for!  The second time is because they wanted my records from a doctor that I had been seeing in this weight loss program for over a year, I sent them that information!  Now, this third time was because the doctor that I saw for over a year, they said that he “was not a hospital affiliated doctor."  I have appealed three times and I don’t know what else to do or where to turn too!!!  Is there anyone out there that can give any advice on what steps to take to get this approved!!  I am in tears writing this letter and need help desperately!!! I will try anything!!!

Thanks,

Carol

Hi,

It sounds like you will be denied, unfortunately, because Aetna is very specific about meeting those requirements in order for them to approve the surgery.  I have Aetna and myself and my three children were all approved, although we all had BMI's of well over 40 so we did not have to prove the specified co-morbidies. 

I am sorry I don't know the answer to your questions, but I would be very curious as to the answer!  Have you tried calling their Customer Service and asking?

Good Luck to you!
Nan

Hello all

I am BMI of 37, with AETNA, and without the specified co-morbidities -  I have pre-diabetes and not diabetes, I have high cholesterol which responds to high levels of medication (not refractory as required), I have GERD (not on the list) , and over the past year put on the 15 lbs  that put me over the 35 BMI.   I'm afraid I won't be covered, so I'm saving pennies etc in case I need to cash pay.

My question - if I cash pay, will insurance cover any complications of the surgery?