Getting Insurance Approval - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

oldgram1 · 07-02-2009, 07:19 AM

The bariatric center I'm working with faxed my paperwork to my insurer, Aetna (PPO) last week. I called Aetna today to check on the paperwork and ask about the approval process. I got a nasty woman (never call 1st thing in the a.m.) who told me it had to go through 3 channels of approval and could take up to 45 days. I am bummed that it would take that long. I expected to have an decision in a couple of weeks. We go to Florida for the winter in mid-October and I really wanted to get this surgery over and have some recovery time before I leave. Needless to say, I'm really bummed. I have jumped through their hoops for 6 months and now it's a waiting game. She said their medical director had the final say and I can just imagine how many pieces of paperwork go through his office on a daily basis.

I can only hope that I got someone on a bad day (it sure seemed that way) and maybe it really won't take that long.

Bumming in Michigan

Gail

supersexysprite · 07-02-2009, 07:52 AM

Better strap in. It's gonna be a long battle.

DO NOT WASTE all of your appeals alone. When you get to that point come back and tell us what was said in the rejection notice. You only have 2 or 3 appeals before the claim is dropped et al. be wise with them.

It can be done even though it seems impossible now.

Be patient

Be more patient

Keep strapped in.

AETNA is among the worst to battle with.

Sprite

poet_kelly · 07-02-2009, 08:14 AM

Hopefully it won't take that long. I know many people are told it can take up to 30 days or something to get approved, but it often goes quicker. I'll keep my fingers crossed for you.

Kelly

Ms. Readytobehealthy · 07-02-2009, 09:15 AM

Quote:

Originally Posted by oldgram1

The bariatric center I'm working with faxed my paperwork to my insurer, Aetna (PPO) last week. I called Aetna today to check on the paperwork and ask about the approval process. I got a nasty woman (never call 1st thing in the a.m.) who told me it had to go through 3 channels of approval and could take up to 45 days. I am bummed that it would take that long. I expected to have an decision in a couple of weeks. We go to Florida for the winter in mid-October and I really wanted to get this surgery over and have some recovery time before I leave. Needless to say, I'm really bummed. I have jumped through their hoops for 6 months and now it's a waiting game. She said their medical director had the final say and I can just imagine how many pieces of paperwork go through his office on a daily basis.

I can only hope that I got someone on a bad day (it sure seemed that way) and maybe it really won't take that long.

Bumming in Michigan

Gail

OMG Gail, first off Welcome to the TT family!!! Second, I am ALSO in the same boat as you. My pw was submitted last week to UHC and as of today.....NOTHING. I'm getting ready to make one of my normal calls to them to check on the status. I'm bummed too and the only thing that has kept me from breaking down is my TT family!!! You will absolutley love it here! Good luck and let's keep connected with each others progress.

jmh324 · 07-02-2009, 07:13 PM

Oh I'm wishing you the best of luck with Aetna as I'm am dealing with them right now. They denied my initial claim, denied after the peer-to-peer, and now we have to appeal. I have an appt. with one of my regular doctors next week basically to see if she can write me a letter of support, etc. I can't tell you how frustrating it's been just trying to make sure my bariatric center got the paperwork to the right people there. I was supposed to have my surgery this past Monday, oh well. I'm not giving up hope. Good luck!

Celestine · 07-03-2009, 06:39 PM

Stay positive, stay focus. Your approval will come. Keep us informed. I have Aetna too and they told me it could take awhile but it didn't. If you met all the requirements you are in. I think this is one of the hardest part of the process. God bless you, stay positive and we will wait for you to give us the good news.

Michie · 07-03-2009, 07:45 PM

With my insurance, my first letter came about 2-3 weeks after submitting. They denied. We appealed with more info that they requested (2 years worth of weight records to prove my bmi has been elavated). Approval came 2 weeks or so after that. Hopefully it'll go smoothly for you... if not, don't give up!

adagirl · 07-06-2009, 08:20 PM

My paperwork was just submitted this afternoon so now I am on pins and needles too. But, I'm expecting what supersexysprite said. I don't think mine will go through without a hitch cause I lost weight in 2007 on WW. I provided records going many more years back to show longstanding obesity and wrote a letter explaining everything, but I'm assuming I will be denied the first time around. I am ready to appeal, though, if needed. And, if I cannot get it on appeal, then they'll have to pay for it in 2010 instead.

FatBeGoneStacy · 07-06-2009, 09:22 PM

Does anyone have Cigna health insurance or heard any stories about if they approve easier then most? How long should you wait before you start calling them? My surgeons office told me not to worry or bother making any calls, that they would handle everything themselves BUT I would only hear from them if it was bad news. In the mean time I'm sew'n buttons over here dying to know.

adagirl · 07-06-2009, 10:22 PM

Quote:

Originally Posted by FatBeGoneStacy

Does anyone have Cigna health insurance or heard any stories about if they approve easier then most? How long should you wait before you start calling them? My surgeons office told me not to worry or bother making any calls, that they would handle everything themselves BUT I would only hear from them if it was bad news. In the mean time I'm sew'n buttons over here dying to know.

I don't have personal experience w/Cigna, but do you know what their criteria are? From what I have read, if you meet the requirements and provide the proper documentation, you WILL be approved. Its common to get denied (even w/all your ducks in a row) because some piece of paperwork/documentation is left out of your packet or was failed to be submitted. But, they just resubmit and everything goes through fine. So, definitely don't freak out if you get a denial the first time. Its most likely just a paperwork thing. If the insurance coordinator at your bariatric surgeon's office is good and experienced, there is less likely to be a mistake like that, but it does happen.

I think the issue of how 'difficult' one company is over the other comes more into play if you don't exactly meet the requirements. For example, I lost weight in 2007 so I technically don't meet the Aetna requirement for 2 yrs morbid obesity. I am sending in a bunch of other documentation to prove 'longstanding obesity' (which is the rqmt underlying 2 yrs). They will probably still deny me, but then again I'm in a gray area depending on who is reviewing my file, whether they consider NIH (National Institute of Health) standards, and even could come down to what they have negotiated w/my husband's employer as to the details w/which they administer the policy.

Ultimately, I don't know if one insurance is really more difficult than another (if you clearly meet the rqmts), but certainly one situation can be more difficult than another. I've had Aetna for so long and let me tell you they can be great in one situation and horrible in another. There seems to be no rhyme or reason. Almost all customer service is outsourced overseas and the billing is all over the place. If I get approved the first go around, it will probably be because someone screwed up (yeah, sometimes it works in your favor), but in that case I will keep my mouth shut!!! LOL