I'VE BEEN APPROVED POST IT HERE

I have UHC EPO and I was approved  I did have to do a documented 6 mo diet history wit my doctor amoung various other tests.

My paperwork was submitted to Aetna yesterday (5-8-07) and they approved it today (5-9-07)!!!

Can you please tell me what you did right to get approve by Aetna ...? I got a call from my surgeon’s office today and they informed me that Aetna denied me.  Any information would be very helpful

Did they give a reason why you were denied?  What did you do before submitting your paperwork?  Did you do the 6 month or the 3 month option?  I did the 3 month and followed the clinical policy bulletin exactly.  I used that as the document submitted to the insurance.  Under each requirement/criteria I inserted what actions I had taken that met it.  If you give me more details I can help answer your questions more specifically.

I did not get the letter yet.  My surgery's office called and just said that Aetna told them that I did not show that I did the 6 month of diet.  I did specify it and stated it on the paper work.   It was back in 2005 the supervised diet.  I think I am going to do the 3 months option and do what you did and resubmit all my paper work again and see what happens.....  Any information would be helpful.... thanks

Tricare Prime rocks the house.  I saw my surgeon for the first time on 4/30 and was approved on 5/8.  That is lightening fast.  I am very impressed with how quickly this happened. 

I GOT APPROVED!  I can't believe it!  It was sent in on Monday and the Patient Coordinator called this morning and stated she received the approval on yesterday!  My surgery date is June 4, 2007!  Thanks for all the support I received here!  I am so appreciative!

After having to do the 6 month diet I submitted all the paperwork to Aetna on May 3rd and got the call on May 8th - I am having Lap-Band on June 20th!!!!  Yay!!!!

I did everything I read on this site to do, constant following up with the Insurance company and doctor's office.  I created my own forms surrounding my monthly visit since some notes can be very vague, and had the doctor's sign off on it believing that too much information is better than no information at all.  I created excel spread sheets and word documents, and ever piece of paper that was created by any doctor that I saw, I had my own copy.  This allowed me to have it just in case someone said they didn't get a piece of information via mail or fax.  BC/BS approved my request today, and faxed me a copy of the approval letter that was generated, so I would not have to wait for it to arrive by mail.  I also took the time to fax my request into BC/BS so I wouldn't have to wait for the mail to take it there.  Here is my timeline if anyone is interested

March 23rd, initial consult (got referal for dietician, psych eval, and fitness eval) March 28 - met with dietician April 4 - had fitness eval April 18th - had psych eval Collected all paper documentation of my appointments from all the places I went and started a file. May 3rd - had follow-up consult May 11th - Dr. writes letter to ins. company requesting authorization for surgery May 11th - I take all documentation and faxed it to Insurance company May 12th - insurance company faxes doctor's office a check list to make sure all info was met and to obtain his signature for medical necessity May 14th - Doctor fills it out and gives to his assitant at end of day May 15th - assistant faxes request to Insurance company, insurance approves and gives authorization to proceed, I requested letter to be faxed and they did at 1:15pm

Now, if only the doctor's office will get off lunch and start answering phones, I can proceed with scheduling my appointment!!!!!!!!!!!!!!!!!!!!!! YEAHHHHHHHHHHH!

Got approved after less than a month AND while the front end workers were telling me the surgery was not covered (THAT part was the MOST frustrating. I had been told it was covered since March and then on May 15 was suddenly told it was not covered; however it had already been approved by then due to medical necessity.  The departments @ insurance companies do not have access to the same info I guess.)   So I am VERY happy with Humana's review process AND Dr. Sonnanstine's office staff who must know what they are doing. My first office consult was in March and my surgery is @ the end of May. Melanie g.