Anybody deal with Aetna?

I am in the process of starting the three month pre-op certification program with US Bariatric in the hopes of getting approved by Aetna. The whole thing is kind of messed up. I was on the verge of getting approved by United Healthcare when my company switched in June to Aetna. I've just now started the approval process with this three motnh program. But now I've learned that after Jan. 1, Aetna will no longer cover WLS procedures unless my employer pays an additional rider fee. There are a couple of questions I have for folks on the board.Has anyone dealt with Aetna? If so, what were your experiences? Has anyone completed the three-month preoperative program with USB or anybody else? Also, Aetna doesn't have any Bariatric Surgeons within a 100 mile radius of my home, so I am trying to find out if they'll approve a non-participating request for Dr. Kim at USB's Celebration office. By the time I complete this, it will Nov. 17, and I'll have less than a month and a half to get approved -- so I am under the gun. Any feedback folks have will be greatly appreciated -- about Aetna, the certification program or non-participating referrals. Thanks in advance.

Hi. I have dealt with Aetna. They have very strict requirements to meet but once you give them what they want I had my approval in 20min after the papers were faxed in. As far as an out of program DR. They approved for me to have surgery with a DR that was not in the program because he was close to my home. I was scheduled to have the surgery on 5/20. Just a couple of days before the hospital cancelled all of the bariatric surgeries that were scheduled until further review. They are still not up and running yet. I had to transfer everything from Ft. Myers to Tampa. Aetna was great in taking care of the change. I now go to Tampa General for all of my pre-op in the morning and surgery on 8/17. Insurance companies can be scary but I asked them what they wanted and got with the staff at the Dr's office. We crossed out t's and dotted our I's and it worked. So hang in there, they will also approve you ahead of conditions being met at a later date. They can say yes you are approved as soon as you finish the diet requirements. Just as an example. i hope that this helps you, Brian

Thanks. That's what we're working on. According to their site and the latest obesity bulletin, Aetna accepts either the sixth month diet history or the three month preoperative regimen, and it also says that they'll pre-approve pending completion... so hopefully it will work out. My physicians office handles all of the paperwork, and they are known for being very impeccable. Thanks for the info. It's just nerve wracking.

Hi Ted, I began my journey with Aetna HMO and was denied due to not having 6 months physician supervised diet ans exercise. Then my company outsourced and I was laid off. Fortunately my new company also had Aetna and my insurance was effective from 1st day. I completed my 6 months the end of Jan 2004 and paperwork was sent to Aetna end of Feb 2004. Aetna of course being an insurance company took the whole 6 weeks they had for processing. Finally, my surgeons office called and spoke with the nurse who stated she wanted to make sure all paperwork was in order before sending to the review board. The surgeons office told her to send the damn paperwork that everything was there...needless to say I was approved less than 1 hour after she submitted the paperwork....6 weeks of waiting for nothing. Anyway, I got my approval on April 2, 2004 and had surgery on Wednesday April 28th...I'm 3.5 months out and down 54 lbs so far. My surgeon was Dr Jawad in Ocala....he is AWESOME. I wanted laproscopic and that is primarily what he does and he has done about 5,000. He should be in your network and he's a wonederful skilled surgeon. Hope this helps. Good Luck and God Bless!!

Ted, good luck with Aetna, I had nothing but problems with them, they jerked me around for two months and then denied me. They required a 6 month physician supervised diet, I supplied the paperwork proving I had done it, Then they said it had to be six month physician supervised diet, with nutricianal counceling, and behavior modification, I was going to have to do it all over again. After being jerked around so long, I gave up and self paid. Good luck, I hope you have better luck than I did.

Ted, I have Aetna POS and I got approval within 3 weeks after my 3 month diet. Aetna does allow you to do your supervised diet with your surgeon now which helped out a lot and saved me some extra trips. Good luck and I hope you get a swift approval!

Hi Ted, I have Aetna POS. I first got denied because I did not have the 6 month physician supervised program. So I started that and a month later I developed High blood preasure and had to be medicated. I sent my appeal letter to Aetna on 4/1/04 which was 4 months into my program and the approved it within a week. My surgeon was also out of network. Hope this helps, Christine

Ted, I have Aetna and had absolutely no problem with them, but the reason for that is because I gave them every single thing they wanted in their list of criteria. I was approved in under 24 hours!! As for surgeons, I have Dr. Jawad in Ocala and although that's a bit further than 100 miles, I'd definitely make the ride to see him. Lots of Orlando folk have traveled and he accepts Aetna. Feel free to ask more questions or email me if you want to. Jan