Approval time frame for Aetna?
Okay.. today was the last day of my 3 months multidisciplinary program. My information is being sent to Aetna for approval for Gastric Bypass.
Of course I am curious about how long it usually takes to hear back but I am getting sooo many different time frames!!
Anyone else have experience with Aetna?
Of course I am curious about how long it usually takes to hear back but I am getting sooo many different time frames!!
Anyone else have experience with Aetna?
Mine was submitted on Thursday and I called them on Tuesday and they told me it had already been approved. That was the good part. My surgeon waits until they have a paper copy of the approval and it took them a month to get it. But the nurse at my surgeon said this was not normal case scenario for this process.
It really depends... on how busy they are, what (and how much) paperwork you submitted, under what criteria you are requesting approval, etc.. (If you have to show comorbidities in order to be eligible or if you have missing or unclear paperwork, that can slow the process down.)
I qualified based on BMI alone and I had my approval the second day after they receieved my paperwork. A good friend, however, who also qualified on BMI alone, had to wait a week. Another person withn Aetna who had to show comorbidities had to wait 2 weeks.
Lora
I qualified based on BMI alone and I had my approval the second day after they receieved my paperwork. A good friend, however, who also qualified on BMI alone, had to wait a week. Another person withn Aetna who had to show comorbidities had to wait 2 weeks.
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
On August 16, 2011 at 11:23 AM Pacific Time, andrea S. wrote:
Okay.. today was the last day of my 3 months multidisciplinary program. My information is being sent to Aetna for approval for Gastric Bypass.Of course I am curious about how long it usually takes to hear back but I am getting sooo many different time frames!!
Anyone else have experience with Aetna?
On August 16, 2011 at 12:49 PM Pacific Time, Lexie T. wrote:
On August 16, 2011 at 11:23 AM Pacific Time, andrea S. wrote:
Okay.. today was the last day of my 3 months multidisciplinary program. My information is being sent to Aetna for approval for Gastric Bypass.Of course I am curious about how long it usually takes to hear back but I am getting sooo many different time frames!!
Anyone else have experience with Aetna?
SW 296
Perhaps your surgeon's program is not set up with the resources to do the 3-month program? It involves monthly visits (and appropriate documentation of the "treatment" plan and "results") with a dietician, exercise physiologist, physician/surgeon (and sometimes a counselor/psychologist depending on who is handling the behavior modification portion). Normally, the surgeon's office does the referrals to the appropriate professionals and sometimes helps coordinate the appointments (so it is more work for their office than just having you do the 6 months program.
This is what the 3-month program requires:
Lora
This is what the 3-month program requires:
-
Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery (within 6 months prior to surgery), member must participate in organized multidisciplinary surgical preparatory regimen of at least three months (90 days) duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions:
- Behavior modification program supervised by qualified professional; and
- Consultation with a dietician or nutritionist; and
- Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.); and
- Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
- Program must have a substantial face-to-face component (must not be entirely delivered remotely); and
- Reduced-calorie diet program supervised by dietician or nutritionist.
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
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