Surgery In Delaware

I have Aetna US Healthcare and have a BMI of 40.7 with no other health problems so far other than back pain. Do any of you have an opinion on my chances of insurance approval??

Sonya, I don't know from personal experience, but have read profiles of some people saying Aetna is awesome! Good luck, and please let us know how it goes with getting your approval. I have BCBSD although I live in MD, because my employer is headquartered in DE. My doc says BCBSD is very sticky about approving WLS (Maryland isn't), so I am also on pins and needles. So many have been approved for this surgery, it doesn't make logical sense that we wouldn't be!

Thank you so much Barbara. good luck with your approval!!!

Hi Sonya. My BMI was 68.8. My co-morbities were high BP, cholesterol and severe sleep apnea. I am down 180 lbs. I have Aetna. The request for surgery is put in 45 days from the surgery date. I was refused the 1st time, then I wrote a letter, gave it to my PCP, who added to it, then to the Dr. Irgau, who sent it to the Insurance Co. and was approved. I have included a copy of the letter in my profile. Dated around Dec 2004. They paid for almost everything. I had a hospital co-pay of $300. I think I had maybe $400.00 to pay out at PMRI for a 1 time Class, Nutritionist and Physciatrist and a few $20 co-pays there for their follow up visits. I made sure that I got the Doctor that Aetna covers. They are not all in network, even though PMRI is a part of Christiana Care. So ask when you make appointments. Dr. Lenhard takes Aetna, however I think he only works 1 day a month. God forbid they cancel on you, you won't get in for 2 more months. PMRI has been a frustrating experiance for most of us. Took me almost a year from the 1st appointment until my surgery date. I'd do it again all over for the results of becoming healthy. Good luck. Keep us posted. Elissa

Elissa...thank you so much. I have a strong feeling I'm going to be denied especially after reading your response to my note. Thank you also for sharing the letter in your profile. I'm going to take a look at it.

Sonya, Go into this with a positive attitude and if it is meant to be, it will be. Aetna wants you to be on a supervised diet for 6 months. I outlined my struggle and attempts in my profile documenting all the weight loss attempts and diet drugs over the past few years. I documented my exercise limitations because of being obese. Don't be discouraged. Even if you have to do another 6 months, there are many others that have been put through the same riggors. Do you have co-morbities? Are you over weight by 100 lbs? These are the first questions I'd address. Have you seen the Dr's yet? Then take 1 step at a time. Try to remain focused and positive. Read some of our journeys. You'll find a lot of similarities in all of us. Good Luck. Keep us posted on your journey. Elissa

Thanks again Elissa. I do not have any co-morbities and although I am 89 pounds overweight, not 100, my BMI is over 40 because I'm short. What I really want is the Lap Band but my insurance covers bypass before they would cover the lap band. I work in medical at DuPont and just told the nurse and physician's assistant who said that for sure I wouldn't be approved and are trying to talk me out of it. I'll keep you posted.

Hello Sonya, I have AETNA and did not have any problems with approval. I was approved on my first try. I know my response is small but I hope that gives you some light. MotherLove

Thank you so much MotherLove!!

Sonya, I have no history with Aetna, but wanted to say hello and welcome you to the DE board and wish you the best. Let us know how it goes for you! Hugs, Tammy