Question for sallykate
Hi Sallykate,
I am researching wls with Dr. Rosenthal and this site. I really need this surgery, I feel the weight is getting in the way of my life...
Soon I will be getting Aetna traditional choice insurance. It seems your having lots of trouble with them approving wls. I checked Aetna online and they say certain plans cover wls if you have documented proof of weight loss and exercise also bmi over 40 , and or bmi over 35 with co-morbidities. I am a nervous wreck waiting to get ins., and then the possibility of them not covering itscares me too. What are your thoughts on this subject. I wish you all the best on your wls journey.
AnnaMarie
I'm not Sally Kate, but I had Aetna HMO for coverage and you should feel free to read my profile if you think it would help, and borrow the letters I have there that were sent with my file. Aetna approved me within 24 hours and it wasn't a hassle.
You can't expect to cut corners with Aetna. The Aetna website outlines exactly what they want and you HAVE to give it to them, or they will not approve you. It's that easy (and that tough).
Hope that helps you a bit, and good luck!
Jan
Hi AnnaMarie,
I am more than happy to try and help you out! Here is the scoop on Aetna...
I have researched my (soon to be little) patooty off and found a common thread with this particular insurance. They stall. Plain and simple they love to stall. I don't know if it is because they hope we will give up or if they are understaffed or plain old unprofessional. I have talked to MANY MANY aetna participants and our stories are identical almost everytime. Jan was a "lucky" one I think. I used Jan's letters in my request to Aetna and recommend you take a look at her very well written letters like she said. (thanx Jan! 
)
I have crossed every "T" and dotted every "i" while jumping through EVERY hoop in the Aetna requirements and know emphatically that there is nothing missing in my paperwork to cause a stall. As a matter of fact, the stall was and has not been about what was in the paperwork at all. It had to do with them losing it twice and not even requesting it from my Dr.'s office after they had been sent the physician codes and procedure codes. It took the nurse 12 days to request my paperwork and that was after 9 calls from me and 4 from the surgeon's office.
NOW hold on... don't quit on me yet. 
... All of the folks that I have talked to that have had this run around HAVE been approved! That's the goal isn't it? So, if you know that you meet the requirements and can do ALL that Aetna requires, then I say go for it if you do not have other insurance choices like I did not. I WILL be approved, I have no doubt. I just have to keep pushing for it. My HR dept. is handling the case now.
One piece of advice that I would give you though is this: When all your paperwork is submitted, log every single call to and from Aetna. Write down the reps. name and the date along with a summary of the call. This has helped me tremendously when I needed to show that I was not getting answers etc.
I sure hope this helps you out some. I so feel for you girl as I KNOW what you are feeling. If you are tenacious...you will have your way.
Hang in there and please please keep me updated! Feel free to email me as well.
Hugs and luck,
Sallykate
)
I have crossed every "T" and dotted every "i" while jumping through EVERY hoop in the Aetna requirements and know emphatically that there is nothing missing in my paperwork to cause a stall. As a matter of fact, the stall was and has not been about what was in the paperwork at all. It had to do with them losing it twice and not even requesting it from my Dr.'s office after they had been sent the physician codes and procedure codes. It took the nurse 12 days to request my paperwork and that was after 9 calls from me and 4 from the surgeon's office.
NOW hold on... don't quit on me yet. ... All of the folks that I have talked to that have had this run around HAVE been approved! That's the goal isn't it? So, if you know that you meet the requirements and can do ALL that Aetna requires, then I say go for it if you do not have other insurance choices like I did not. I WILL be approved, I have no doubt. I just have to keep pushing for it. My HR dept. is handling the case now.
One piece of advice that I would give you though is this: When all your paperwork is submitted, log every single call to and from Aetna. Write down the reps. name and the date along with a summary of the call. This has helped me tremendously when I needed to show that I was not getting answers etc.
I sure hope this helps you out some. I so feel for you girl as I KNOW what you are feeling. If you are tenacious...you will have your way.
Hang in there and please please keep me updated! Feel free to email me as well.
Hugs and luck,
Sallykate 
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