New to board

Hi, My name is Lillian and I just recently found this website and the board. I live in Orlando and have decided that I want to have the Lap RNY surgery. The problem is right now that my insurance carrier is going to be changing as of 01/01/05 to Aetna HMO. So I haven't really done anything as of yet since I don't know of what I can do. I am planning on going to an information session at Celebration Health, where I want to have the surgery done, on December 1st. And I was going to go to my PCP sometime this month or next month to start the whole process, but I haven't ever been to this PCP and I am worried about them telling me that they won't support my decision for the surgery. I was also going to call my OB/GYN office since they have all my records of weight for the past 5-6 years and that is about the only doctor that I have always consistently went to for all those years. Does anyone have any advice for me? I have gone to the Aetna website and printed out a copy of their clinical policy for the obesity surgery so that I can bring it to my PCPs office and I am hoping that will help us in getting it all approved. I am so nervous, this was a hard decision for me to make, but I knew I couldn't put it off any longer. Thanks for reading! Lillian

Welcome to the board, as far as advise... I have very little yet. My process was fairly easy, my insurance has very few requirements. Get together all your documentation on diets and exercise ect. Some insurance companies required 6 months to a year of a docter followed diet. Read alot of peoples profiles, just click on their name on the board you will get a wealth of information PS: everyone on this board is very friendly and helpful

Lillian, I am fairly new to this site as well and have found it to be a wealth of information. I have learned so much - even questions I did not know to ask. Everyone on this site has every one else's best interest at heart. I guess we are all in the same boat. Although I don't know what your insurance will require you will speed up the process by bringing with you a list of all dieting attempts with dates, whether or not they were doctor supervised, and a list of all medications you have taken. The doctor and the insurance company will definitely ask for this info. Good Luck! Lynn

Lillian, Welcome to our little spot on the site! Here are my suggestions regarding Aetna: 1) In additiona to your PCP, I would get your Ob/Gyn to definitely write a recommendation letter since they have your weight history for several years. 2) Call Aetna and find out what they require for approval and start the process before the Dec info session. Ask if they require a 6 month supervised diet (that is always a let-down if you dont know about that upfront). 3) Contact your employer's HR department and make sure there isn't an exclusion in their policy for WLS (recently someone on here found out her company had this exclusion and it was a huge blow) FYI: When you go to the US Bariatrics info session, they will answer a lot of your questions regarding surgery and you will meet several post-op success stories and some of the staff. The session is informative and straight-forward. Dr Kim is well-respected and likeable. They have a Q & A session but their answers about specific insurance requirements will be vague, so do your homework ahead of time. You will get a huge packet to fill out that you mail back or fax back to them, then they have a nurse call you and review the info with you over the phone, then they will set up an appt with the surgeon. Somewhere in there is a lot of required testing that has to take place. The whole process prior to approval takes several weeks, so anything you can do now to expedite the process is to your advantage. I went to two info sessions there and was very excited about their practice and after-care, but they didnt take my insurance and the insurance process was becoming a hassle so I found another surgeon. Good luck

Hi Lillian! You've been given some great advice, but I did want to welcome you to the FL board! We've got a wonderful group of people here. I wish you all the best in your approval process. Hugs, Erika L

welcome

Lillian- Welcome. I am very new too. But I have a couple of suggestions in addition to those already given. I know this is a hard decision to make. But stay strong and do not let bumps in the road weaken your resolve. First I would make sure US Bariatrics accepts your insurance. Second I would call the PCP's office and ask if this doctor has ever referred any of his patients for WLS. If he hasn't then ask if he has a policy on WLS. Some Docs will never refer you and there is no sense barking up that tree if the possum aint there. If that is the case you may need to see if there is someone else you can use as a PCP. Go to the insurance page on this web site and scroll through to the more recent Aetna entries. You may find the names of some PCP's who have helped their patients through the process in the comments. Or when you find someone from your city (who was approved) click on the link and write them an email and ask them who their PCP was/is. I think you will find most everyone who is registered on this web site is very willing to help, even if they do not participate in the message boards. I have gotten a lot of pertinent information on dealing with my insurance (Tricare Standard) this way.

Hi Lillian and welcome to the board! I have Aetna HMO and they approved me in under 24 hours, but I gave them exactly what they required the first time around. Don't even think about cutting corners because it won't fly. You have to have proof of past diets and your doctor's office notes, and at least 3 months of physician-supervised diets within the last year IF you have enough past diet history. I have two letters on my profile that you can use if you want, and I have NO idea if those letters helped or not, because the Aetna site specifically says that they want office notes. Good luck with your approval!! Jan

I just wanted to say WELCOME TO THE BOARDS!!!!!!!!! you've been given great advice, just one more tip.....make copies of everything to keep for yourself, and write down all the names of the people you speak with at the drs office, insurance co. etc......you never know if something could get lost or misplaced. Good luck on your wl journey and keep posting. Tammy

Thanks everybody!!! I am very grateful for all the advise and information given. I did read the policy for Aetna and they just changed it saying that you need a physician-supervised nutrition and exercise program OR a multidisciplinary surgical preparatory regimen in order to be approved. I was originally going to just wait until Jan 1st when my insurance changed to do anything, but now I am excited about the prospects of this actually happening, so I am going to start working on getting all my "ducks in a row"! Thanks again!! Lillian