A Newbie Asks about Insurance (Aetna, etal.)

Hi - I am brand new to this site and am still in the investigative stage of picking a surgeon and learning about insurance approval. Q-1: Have any of you decided to go out-of-network for surgery because you felt an out-of-network provider was better than in-network? (I'd be curious who was in-network for you and who you chose out-of-network.) Q-2: For those of you who have Aetna (I have Choice POS): did any of you get APPROVED contingent on having a 6-month medically supervised diet first? Did any of you get approved without having a 6-month supervised diet within previous 2 years first? I read on this site about denials & subsequent appeals because of not having the supervised diet, but Aetna's Clinical Policy Bullentin reads that approval may be given contingent on completion of a medically supervised diet/exercise program. Patricia

Hi Patricia.........Since you mentioned....."Aetna's Clinical Policy Bullentin reads that approval may be given contingent on completion of a medically supervised diet/exercise program. " ....... I would definitely talk with your personal doctor about starting a regimented diet program with him and one that keeps very close records and checkups. I would try to get a written letter from the insurance company as to exactly what they expect and want. It's way too frustrating to find out later that there is something missing, especially if it takes some time to complete. Be very patient with the process, but at the same time be very vigilant and persistent. The more you can do up front to jump through all of the hoops, the happier you and the insurance company and your surgeon will be. I would also get a complete list of all of the approved surgeons in the state as this will save you time from heading in the wrong direction. Let me know if I can help with anything....