AETNA/Insurance

Has anyone gotten approved without the 6months diet report in the previous 2 years? I have reports from 4 and 5 years ago that I was told would count but have been denied.

have you gone to ww or has your pcp documented anything. If not get started on it so they will approve you. Be glad you can still be approved. Our company put in an exclusion as of 1/1/04

My pcp sent his progress notes from 4 years ago when I was taking redux as AETNA said that would count but then they denied it again. Also, since they have not one briatric surgeon in the state of Ohio enrolled in their plan, I am being penalized for that .

This is just a question trying to help but did you look under general or vascular surgeon. A lot of those also do bariatric surgery too but they just do not list. I am sorry you are having problems. Insurance can be he**

Sue, Aetna is very picky about this issue, however, they did accept my weigh****chers weigh-ins because my PCP had documented it in his records that I was doing WW - therefore it was considered Dr. supervised. There are many bariatric surgeons in Ohio who are "in network" for Aetna insurance - though maybe there are none at the facility you are going to.(I went to Bariatric Treatment Center and the whole thing was out of network - hospital, surgeon, all of it and Aetna still paid all but 1,500.) The surgeons at OSU are in network as are a few in the Cincinnati area.

AETNA's costumer service rep is the one that said they had no 'in network' surgeons in the state of Ohio. I am seeing Dr, Hess of Bowling Green and he is not in their plan so I pay 60% and AETNA pays 40. But if I am denied again I will another 'in' surgeon

I have AETNA (my first mistake as I do have other choices) and it has taken me over a year, but I was finally approved last week and only becuase I got them on a technicality. I was denied last year because I did not have a physician directed diet (that was the only required criteria). So, for six months I went on the diet and Susan at Dr. Gersin's office (she is fabulous by the way) re-submitted. Well, of course they denied it. This time because they said I didn't have a nutritionist. WELL....I ended up calling the physician who made the decision and informed him that the denial didn't say anything about a nutritionist and that they were changing their rules mid-stream. Susan faxed him a copy of my originial denial (which said nothing about a nutritionist) and he reversed his decision. But I really had to fight for it. Aetna is very, very strict in their adherance to their criteria. You should go to their website (www.aetnal.com) and print the criteria for obesity surgery so you'll have it. Also their are several surgeons who take aetna, Dr. Gersin for one. Good Luck!