Oh NO!!! INSURANCE!!!

Has any one had experience with aetna insurance in maine?  I am still waiting for my doctor to make the referral, but I am so scared my insurance won't cover it.  What kind of things are they looking for?  I expect the process to take a while...but now that I have decided to pursue this, I just want it to happen.  It has been almost two weeks since I saw my physician and the referral still isn't sent...frustrated.  

It is frustrating to have your future health out of your hands in this way. Stay strong. Does your doctors office have a patient advocate or office manager who can help get your paperwork out of the doctors office and on to insurance?  

I was told that my insurance may not approve me bc I lost the 15 lbs I was told to lose too quickly and that I should regain. Felt like I can't win. Insurance is frustrating. Keep a positive attitude and keep working on healthy habits. 

Good luck,

lisa

You have to read YOUR policy.

Aetna offers a wide variety of coverages, then subscribers (or employers) choose the benefits they want to cover.

one person with Aetna may have WLS coverage and another may not.

Generally, WLS gets approved if a person has a BMI of 35 and 2 co-morbidities or 40 BMI with 0 co-morbidities.

I had to deal with Blue Cross in PA and it was 18 months of jumping through hoops. I was scared the entire time.

So here's what I'd say:

Get a clear list from Aetna of exactly what they require. Start clicking through the list. 

Get your own copies of everything - every doc's report, clearance, etc. - keep your OWN files every step of the way. 

Verify submission of everything to insurance.

Work closely with your surgeon's insurance rep. 

Learn the name of one consistent contact person at Aetna.

It probably won't be as bad as you think but just in case, be prepared!

And someone else already said, make sure you find out exactly what your Aetna policy requires. Then, above all, be sure to provide everythign they ask for because they WILL deny it if your surgeon's office fails to provide all the info. Make sure that if they ask for a weight history, you provide it for the specific time period.  If you don't provide that, they will automatically deny it (it was The first item on their approval checklist 8 years ago) and you will have to appeal.

I had Aetna, completed the required "multidisciplinary" 3- month program (not available on all plans... Some require 6-month diet), and once they finally got my information (first fax of all the info somehow got lost), I ahd approval in 2 days (but I qualify based on my high BMI alone, and didn't need documentation of any comorbid health problems).

One warning: if they give you the 3 month multidisciplinary option (a 3 month program with doctor/surgeon, exercise physiologist, and dietician instead of just a 6 month supervised diet), you have to complete three full months, which means meeting with each if those people FOUR times (the first visit starts the three month clock and the fourth visit at the end of the three months completes it).  If you have only three meetings with each instead of four, they will probably deny the approval.

Good luck.

Lora

Goodness - stop fretting and give them a call yourself!  They should be able to tell you what all is necessary for approval and what procedures are covered.  Don't wait for your doc to get around to it.

I did mine through aetna. They were great. They emailed a very detailed list of everything that I needed. Then I took that with me when I went to the surgeon's office. I didn't need a referral. I just called the surgeon;s office and went a information session. 

Find a copy of your benefit book-- you can often find them online or HR may have a copy. They should have a list in there of exactly what they cover and any requirements (BMI, comorbidity, etc.) for them to pay out.

I have AETNA but I'm in AK and a state employee so I have to call my benefits administrator for the list of requirements.  It was really helpful because my surgeon's office thought I needed more documentation than I actually did.  You should call them and have them send you their list. I'm waiting on my referral from the surgeon for medical clearance then they are going to submit the approval request.

I had Aetna in Texas at the time of surgery and they were very responsive. I didn't have to do the 6 month supervised wl they required because of comorbidities, I guess. I had to provide weight history for 3 years. I have no complaints.