Have Aetna need Revision...how long should approval or denial take
I have had my band for 2 years which was self pay and am needing a revision to a sleeve and now I have Aetna. I had my sleep study last week with no sleep apnea and my endoscopy last week with Dr. Kim, he said I have a slipped band which has been empty for weeks. His office submitted everything to the insurance today and said we will have to wait to hear from them. Has anybody else gone throught these steps with insurance, how long does it usually take to get an approval or denial?
When I originally was looking into doing a Lapband revision to my RNY Aetna had my approval in 2 days! I've changed my mind to a DS revision and am now awaiting my pulm clearance and Nut eval to refax to surgeon and they will resubmit.
Aetna is very quick and I don't see how they will deny you since your band had slipped and it is a medical necessity.
Good luck!
Aetna is very quick and I don't see how they will deny you since your band had slipped and it is a medical necessity.
Good luck!
Kerry J Stillhopefull (Terry) is my Angel!!!!
Angel to Baylady35310 (Linda)
7/9/01 RNY - 354 HW down to 192 LW
12/6/10 DS Revision - GW 170
DS HW 353
DS SW 332
DS CW 184 (-148 since surgery / -169 total)
Plastics completed by Dr.Sauceda in MX 8/9/13 - LBL w anchor cut, long thigh lift, breast lift, butt augmentation and arm lift.
Getting a revision on Monday with Aetna and it took about a month to get approved. You have the advantage of a slipt band on your side as I did not have that . Aetnas major requriement is that you are at least 2 yrs out from your original surgery, and that you still have a high bmi- which recquired you to get surgery the first time.
RNY on 12/09/13
I am almost in the same boat you are in. My band slipped so I had it out October 1,2009. Since my BMI was too low at the time my band was removed I did not qualify for any type of weight loss surgery anymore. My esophagus was also very enlarged so my surgeon wanted to give it time to possibly shrink. Plus,I was not interested in the full gastric bypass and VSG was still considered experimental.
Since having my band removed I have gained just over 50 lbs so now I qualify, but since I don't have two consecutive years of being over weight I have to go through three months of nutritional classes. I did my first class last Monday and have to do 3 more. I currently see a psychiatrist so I have to have him write a letter saying I'm stable enough to follow a pre-surgery and post surgery regimen and instructions. The hospital my surgeon practices out of also makes you do a fitness evaluation to see what you are physically able to do. They will then resubmit my pre-certification hopefully it will be approved this time. So if everything goes smoothly I should be able to have surgery in late August early September. Aetna has 15 business days after receiving your clinicals to approve or deny your request. They took the full 15 days to make a decision even though I called them at least twice a week. I was told by Aetna's customer service that might help speed up the process (they were wrong).Hopefully your case worker will move faster. Good luck!!
Since having my band removed I have gained just over 50 lbs so now I qualify, but since I don't have two consecutive years of being over weight I have to go through three months of nutritional classes. I did my first class last Monday and have to do 3 more. I currently see a psychiatrist so I have to have him write a letter saying I'm stable enough to follow a pre-surgery and post surgery regimen and instructions. The hospital my surgeon practices out of also makes you do a fitness evaluation to see what you are physically able to do. They will then resubmit my pre-certification hopefully it will be approved this time. So if everything goes smoothly I should be able to have surgery in late August early September. Aetna has 15 business days after receiving your clinicals to approve or deny your request. They took the full 15 days to make a decision even though I called them at least twice a week. I was told by Aetna's customer service that might help speed up the process (they were wrong).Hopefully your case worker will move faster. Good luck!!
I am currently waiting on Aetna to send an approval for a Band to RNY revision but the staff member that handles insurance is harder to get in touch with than the surgeons themselves. It's been a month since I completed my psych eval and that should have been the last of the requirements they needed to send to insurance. I was supposed to hear "early this week" but I can't seem to get ahold of the insurance worker. I was told it was supposed to take a week for them to get back but now I'm starting to get worried. I had surgery almost three years ago and gained back what I lost plus a little more. My doctor has documented having continual trouble with vomiting and weight gain and said insurance shouldn't be a problem yet but we haven't heard anything. Should we take this as a bad sign?