Aetna - Approved 1st submission

I have been approved on the first submission to Aetna and have my Open RNY scheduled for 2/20/07.  Basically what I did was my homework! I got copies of my medical records which my PCP had regularly noted my weight ( and I use to complain about being made to get on that scale everytime I walked through the door...never again! ) I made sure I had all of my weight loss attempts documented and most of all with the help of my Surgeons staff (Dr Randall) I followed Aetna's 6 month requirements to a T.  Good Luck to you all!!  Rosie C

YEAHHH! Congratulations Rosie!!  And you got a February date too! That's wonderful! I hope to have the same luck with Aetna.  I just found out that my case was submitted a few days ago.  It's under review right now but I hope to have some good news soon! How long did it take for them to approve you? Angie

Hi Angie  Thank you! It took exactly one week to get the approval - my Dr's office submitted my paperwork the afternoon of  01/17 and got back the approval 01/24 in the afternoon  Good Luck and I'm keeping my fingers crossed for you!  Rosie

Congrats on your approval...May I ask exactly what you followed to a T..I am currently in the process of going threw my process with Aetna and jope I too wil be approved on the first go around.... Asia

Asia  Since the criteria includes that the presense of severe obesity  that must have persisted for at least 5 years I made sure I had copies of my medical records that consistently documented my weight. You must also show documented attempts at weight loss (that you were unable to sustain) which I also had documented in my medical records and I also had copies from an 18 month attempt with Jenny Craig. I followed the 6 month Dr supervised nutrition/exercise plan (which has to be consecutive months) and I also attended monthly support group meetings ( not a requirement but a great idea!)  The day I had my last Nutrition appt they submitted the paperwork and approval came back one week later.  Good Luck!  Rosie

I have Aetna insurance and my doctor submitted all of my info to Aetna and they sent a letter back saying my procedure was covered from the diagnosis and info sent in but it also says its not guarantee of payment until the procedure is complete. Did your approval letter say this also or did you get an actual aprroval number? Not quite sure how to take this one!!!!

I got the approval letter from Aetna it shows coverage for the RNY has been approved and 3 Days Surgical has been approved - my letter does have a reference number. The only other things it says if my hospital stay continues beyond the days reviewed on this letter, another review will be conducted........it also states I do not need to notify them that I am still hospitalized ....states next review date will be 02/23/2007 (which should be the day I am scheduled to go home)  Rosie

Which Aetna do you have?  I have Aetna EPO.  I am in the process of doing the 3 month multidisciplinary diet with my doctor.  I have my medical records that show my weight for the last 8 years and my attempts at weight loss.