peanoko

Hello all. I have Aetna PPO and was wondering if anyone has that plan. I was just curious if anyone had any troubles with approval.

Toony

Hi, I have Aetna... my paperwork was submitted on Nov. 3, but who's calendar watching?

LOL! ME!

You will have to follow a 3 or 6 month plan... do you have the guidelines?

I'll try to find them and post here...

katie

EDIT: Found it

http://www.aetna.com/cpb/medical/data/100_199/0157.html

Print this out and give a copy to the the secretary in your surgeon's office..... good luck!!!

__________________

Toony & T-T 4-Ever!


Lap RNY: FAT TUESDAY! 02/05/08
Lost 104 pounds, about 50 to go!
TT Sponsor #11

peanoko

I was told I have to go through a 12 week program. I am a little concerned about my weight history. That is hard to get.
Good Luck to you Kate. As hard as it is good thing's are worth waiting for. I am sure everything will be fine.

Debz

I have Aetna PPO and they approved me no problem. There was a six month doctor supervised diet required, but I know they also have the three month multi-disciplinary track. For that, I think you have to see a doctor, a dietitian, and receive counseling for a three month period, but because I didn't do that, I'm not quite sure of the exact details.

I, surprisingly, found them extremely easy to deal with. They didn't even ask for my 5 year weight history, but I think that had something to do with the fact that I'm a diabetic. Good luck in your journey.

__________________
Debbie
Lap RNY 8/6/07
Highest/Day of surgery/current/goal
251/237/126/131


Goal! I did it!
111 pounds gone since my RNY
125 total pounds gone forever!
Maintaining within a few pounds up and down. 130 is my goal and I've been hovering a pound or two over it for months now.
BMI 22.3


I am not a tame lion......

janine

I had Aetna ppo...
They have 2 options...
I chose option 2..

Dr.'s letter of health prior to diet and recomendations for diet plan
3 months supervised diet by dietician
3 visits with nutricianist (once a month)
3 months of 3x week exercise plan (documented)
I chose the ymca because they log your visites
phsyciatric evaluation
dr's letter of health and recomendation letter from origional Dr.
5 years of documented weight by doctor (to show long term obesity)
There are other things I had to prove Like my bmi, high blood pressure, sleep apnia, border line diabetic, ect..

My doctor required:
Pulminolgist exam
cardiologist exam

After all this documentation I was approved within 2 weeks.

Sounds like alot and it is... They want you to prove it's necessary.

good luck!

__________________
Janine344/310.4/176.4/117 (6/15/08)
-33.6 lbs (pre-op) -134.0 bs (post-op)
-165.0 total loss)
Lap RNY 10\23\2007 Dr. Juarez
gym Rat #68 (11/07/07)
Boo Boo Bear (TT Bear member) (02/04/08)
Ducksack club member #6 (02/06/07)

journey to success

shaxmom

Your insurance guidelines sould alot like mine. I am just starting this process and was given the outlines you listed. Is it realistic to think, if I get all the required documents together while doing the 3 month diet, surgery can be done before March 1?

Toony

Your doctor may have guidelines as well. Once I'm approved, I have to see him and the dietician... and follow a 2-week diet... depending on how booked up the appointments are, it could take awhile... Nothing is easy --- and waiting for approval and the surgery is time to spend reading, researching, changing habits and your lifestyle.

Best wishes!

__________________

Toony & T-T 4-Ever!


Lap RNY: FAT TUESDAY! 02/05/08
Lost 104 pounds, about 50 to go!
TT Sponsor #11

Jeri

Or you could do what I did...which was lose all patience for the approval process and moan & complain about how long it took. Just kidding...it's a tough process & every surgeon & every insurance co is different. There's no way to know when your surgery date will be.

__________________
Jeri
Lap RNY 10/30/2007


Height 5' 5 1/2"
HighestCurrent/Goal
278/243.6/199

God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

Ataraxia

I have aetna PPO as well. I've been on dozens of diets in the past but none that meet their criteria so I'll be starting my 6 month medically supervised diet. I'm curious about the 3 month multidisciplinary criteria. I would much rather go 3 months instead of 6 months but the criteria concerns me. Afraid I'll do it wrong and it won't meet the standards that they are looking for. My other concern is that i'll actually lose some weight, not a lot but enough for me to no longer meet the criteria for the surgery. I'm on the low end of morbidly obese just a few pounds lower and I fear they will reject me once I lose any weight on the 6 month diet or they will reject me for not losing or gaining on the diet. My biggest fear right now is the insurance approval. I'd hate to get my hopes up only to get turned down. Even if I lose a little weight I'll still be obese and still at increased risk for disease but insurance companies seem to only care about some pre-defined criteria they come up with. Ironic thing is that I lose 15lbs before I had my first consultation. Oh well. What is meant to be will be. I'll fight for this because I deserve it. Keep me updated with your approval process it will be nice to go through this process with someone else.

peanoko

Hey all. I started my 12 week diet today. I am so excited. I have all of my appointments set and meet with the surgeon on Feb. 4, 2008. I was told my surgery will be the end of Feb. I found out the details for what I have to do for approval. I need to meet with the dietition and nurse practitioner 3 times (once a month) which I see both the same day. I also need a 5 year weight history and a letter from my PCP. I have to attened a support meeting. Then I need to take a test. Oh and see a psycologist and go for blood work. Sounds like alot but I already have alot of it done.
Everyone keep me posted on your progress and good luck to all.