Anyone have any trouble getting approved by aetna

hi i have aetna pos choice II. i an just beginning the process to to lapband and was wondering how hard it was to get approved by aetna.. i am 5'4 and i have a BMI of 41..
acid reflux/gurd
herniated disc
rapid heart beat at times
and sore feet and legs
lower back pain
shortness of breath..

well thanks in advance to all *****ply to this thank you.........

Aetna's requirements are posted online.  I have a POS policy with them as well.  Unfortunately, the co-morbities you listed are not taken into consideration by Aetna.  The good news is that if your BMI is 40 or over you don't have to have any co-morbities.  If your BMI was 35-39.9 then they require that you have one of their specified co-morbities (like diabetes, high blood pressure, etc).   They require medical records from the last 5 years showing that your BMI was 40 or above (could be lower if you have some of those co-morbities they specify).  They also require 6 months medically supervised weightloss.  If you don't have the medically supervised weighloss they will accept 3 current months of medically supervised weightloss as part of a pre-op diet.  Here's the link so you can read for yourself.... http://www.aetna.com/cpb/medical/data/100_199/0157.html You should be subject to these guidelines unless your policy specifically excludes WLS under any and all cir****tances.   Good Luck! (I'm 3.5 weeks away from being able to submit my surgery request to Aetna, so keep me posted with your progress.  I hope neither of us have trouble with the approval.)

Another question, I also have Aetna and the 5 years of medical records may be a problem. Ive moved and I think my old doctor did too. Do you know how they will handle that?

I'm pretty sure Aetna is going to require at least one medical record from each year.  Even if the dr has relocated, they should still have copies of your records.  Most dr's will charge $1 per page of medical records not to exceed $20 or $25 unless they are sending them directly to another dr.  If you can't get those records, try to think about an annual well woman or ER visit you may have had during those years. I've read about some people writing the insurance company a letter if they did not have any records from that year.  I'm not sure how this works.  The only one that I heard was successful was a patient that had Weigh****chers records from the year she had no office visits.  The insurance accepted those records as verification of her weight for that year.  Some people on OH recommend photos if you just can't find any records.  I really don't know if photos would work. Let me know how it goes with Aetna. Good Luck!

sorry about the "well woman" comment....I didn't even think to check if you were male or female.  So sorry  :-)

No i am a woman. Thought nothing of it

I have read Aetna's Obesity Surgery bulletin #0157 five or six times, and also interpret it as you must have six months of a doctor supervised diet and exercise program OR three months of a multidisciplinary program meeting their stated criteria (which mine does). I have Aetna's Patriot V plan through my employer and my surgeon requires that you participate in a a pre-op program called New Beginnings, which I believe meets the three month multidisciplinary requirement.  This program costs me $1,700 out of pocket, non-reimburseable through insurance. My file just went from New Beginnings to my surgeon's office for submittal to Aetna, but my surgeon's scheduler is giving me fits about not meeting the six month requirement.  I keep telling her that by my interpretation of the criteria, I don't have to meet the six month requirement if I meet the three month requirement.  I even called Aetna and verified this with them.   Of course, the scheduler has a lot more experience with this than I do, so I have no reason to doubt what she is saying.  She feels Aetna will deny my request.  My file was submitted to Aetna this week and I'm sitting on pins and needles wondering what the heck is going to happen. My BMI is 37, but I am the co-morbidity queen:  diabetes, high blood pressure, high cholesterol, GERD, arthritis, sleep apnea (diagnosed through pre-surgical testing). I'm in a time crunch here because I want to have the surgery the middle of June so I can take the rest of the summer to recuperate (I work for a school district), and I'm concerned a denial will screw up my schedule. I kind of expected grief from the insurance company, but not from my surgeon's office!