State of Alaska AlaskaCare Insurance

Has anyone covered by the State of Alaska's AlaskaCare Insurance program had trouble getting approval for gastric bypass surgery from the State's claims administrator, Aetna HealthCare, in Washington? It appears that the claims staff for Aetna HealthCare may have been using an inappropriate policy and criteria for adjudicating AlaskaCare requests for surgery for the last several months. From what I've been able to discover talking with a number of people, the claims people for Aetna HealthCare have been using criteria that applies to people who actually purchase their insurance from Aetna. When ruling on a request by an AlaskaCare participant (Supervisory, Retiree, etc), the claims staff is suppose to use the criteria outlined in the State's Group Insurance Information Handbook. If you or someone you know covered by one of the AlaskaCare programs has had a problem with Aetna approving a request for surgery, you may want to contact either the Division of Retirement and Benefits, your bargaining unit representative, your legislator, and/or your doctor's office. Ask them to make sure that Aetna HealthCare is using the proper criteria in your case, Only the requirements listed in the AlaskaCare health plan book should be used. I would like to hear about the experiences others have had with obtaining AlaskaCare approval. I am expecting that I will still have to file an appeal to get the proper approval for my surgery. The experiences of others might give me inspiration and encouragement. Good Luck to you all.

LeRoy, I thank you for your post. I just faxed off the paperwork that Aetna asked for and was kind of upset that I needed so much more than what the state plan said. The nurse told me that they administer for the state and that when they make changes it applies to everything. I was going to contact the state about this. Aetna is my secondary and my primary has already approved and I'm scheduled for surgery next month. I will be calling the Div of Retirement & Benefits Monday.