Who has AETNA insurance and how hard was it to get approved for surgery

Hi... I have my 1st consult with the surgeon next week.  I have been referred by my primary care physician and my BMI is 44.  I was wondering how hard it was to get approved for surgery by AETNA insurance?  Thanks!!!

I went to see the surgeon for a consult in November. I started the 3 month supervised diet then. In February my paperwork was submitted. I was approve on my Birthday and had surgery 3 weeks later. So I didn't have any problems with Aetna at all. So far they have covered everything and my surgery cost me $15.00


Good Luck with your journey and I hope it's smooth sailing for you too....

Hi Brandi,

I have Aetna and just finished my prep work for Gastric Bypass Surgery.  I have my surgical date and prior authorization for Aetna should be submitted next week.  So, although I don't know the outcome so far, I can give you some information on pre-surgery requirements.

Not all Aetna plans cover bariatric surgery, you can call customer service to find out if yours does.  If it is covered, all plans go by the Aetna Clinical Policy Bulletin: obesity Surgery 0157.  This document outlines what is required for Aetna to cover your surgery.

You can do a Google search for Aetna CPB 0157 or go to the attached link.
www.aetna.com/cpb/medical/data/100_199/0157.html

I hope this helps!!!!

WOW, That is great news! I hope I am as successful as you.  Congrats on your success!

I didn't have any trouble with Aetna either. My surgeon's office told me Aetna is one of the better companies. I paid more than Chynalyz did but it all depends on the plan your employer has chosen. The best part of Aetna is they only require 3 month diet pre surgery and not 6 or 12 months like many others. Good luck on your journey!

If it's helpful, here are the guidelines for WLS for Aetna.  http://www.aetna.com/cpb/medical/data/100_199/0157.html

It was a very easy, smooth process for me.  Once the doctors office submitted everything, I was approved within 30 days.

When my surgeons office submitted all the collected data/test results AETNA approved my surgery the same day.

Once I had my documentation for the 3-month supervised visits with doctor, exercise physiologist, and nutritionist all pulled together, I had no trouble getting approved (within a week).  Of course, with my starting BMI (even with no comorbidities), there wasn't much doubt about it (but I still worried that they wouldn;t approve it).

Lora

I did the 6 month supervised diet and was approved shortly after papers were submitted.   I had very detailed doctor summaries.

Gail

I have Aetna TRS-Care in Texas. I finished my pre-approval process on Dec. 8th and got the call on Dec. 16 that I had received final approval. Now waiting on surgical coordinator to call. I have an annual $3000 out-of-pocket expense limit to meet before Aetna will pay at 100%. My surgery will probably not be until the end of Jan. as that is when my sister can come stay for a week as I recover.