Aetna PPO Concerns

Hi all.. new here and hoping to learn more as I go thru this journey. I went on the 20th for my consult and things seemed to go well.. met with Dr. Jones and she is very impressive! I liked her from the moment she began talking. I have a lot of concerns at this point but they arent in regards to the surgery itself... its getting the approval! I have Aetna PPO and my concern is not having enough documented attempts over the years. I know I have tried most everything as most of us have but I dont think a lot of the things I tried I even mentioned to my PCP. I have a BMI of 50.0 and the only co-morbidities I have is Obstructive Sleep Apnea.. I am on a Cpap but have been told the SA is considered mild. So again I fall back into an insurance coverage issue and worry... Has anyone here dealt with Aetna and had what I have or lack there of for a better phrase? I am willing to do whatever I need to, to get this approved but would love to know that I have a chance... 

Thanks for any help... !

I did not have Aetna so I can't speak about them but I have noticed that persistence pays off.  Don't loose sight of the goal and go through what ever hoops the insurance wants you to do. I was denied the first time but 1 week later after more documentation submitted I got my approval letter. DR. Jones is Great.  She was my surgeon and is a great encourager. Remember then is a life long journey.  I am 8 weeks out and working very hard to make this a success.  I am walking 10000 steps a day for the last week and hope to get it to 10000 aerobic steps by the 3 month checkup with Marta on July 11th.  I try not to focus on the weight loose and focus on the behavior changes made.  The procedure has allowed me to accept that activity is needed and EXPECTED for the rest of my life.  Start NEW habits now and things will go better. Hang in there and I will pray that God's will be done.. Bless You Emil

Hi, You might want to check to see if your plan even covers WLS.  I used to work for Aenta, not everyone that has Aenta have the same plan-some will cover it some won't-it depends on if your employer wants this as one of your benefits.  Then call and speek with a rep from Aentna...ask for your plan booklet or if its online check the exclusions of your individual plan.  In the meantime your Dr will be able to help gather all the necessary information to submit to you plan to start the approval process. Best wishes and stay persistent!  

Hi -  I have Aetna PPO and got approved back in April and had my surgery 7 weeks ago. 

The first key is to determine if the policy your employer purchased covers WLS.  That's the key.  Make sure it hasn't been excluded.  They did require that I do a 6 month supervised weight loss attempt prior to sending everything in for approval.  So.... I did the 6 month supervised WL w/ the clinic. Also have only mild sleep apnea as for co-morbidity. Was put on CPAP in January. Provided medical records to show that I had been above a 37 BMI for at least the last 5 years.  (Requirement is BMI > 40 or >35 w/ co-morbidities).  These were general doc records for other visits where they'd recorded my weight - not specifically to go to lose weight.  I did initially get denied but that's because we'd only initially sent the records from my current doc and that was only 2 years worth.  They now require 5 years of medical records. Once we sent the additional records, I got approved.   Good luck to you!  Lynn