Aetna EPO

I was wondering if anyone has any personal experiences with Aetna EPO? I see that alot of people have used Aetna on here but most that I have seen were not the EPO. Anything that you know about their requirements would be great or just general experiences. I have not had my consultation yet its on Sept 13 and I am very nervous about my insurance company.

I had Aetna PPO. What I'd suggest is that you contact Aetna and get their requirements BEFORE you go to your consult. Aetna is really good about giving them out. This way you'll know exactly what hoops you have to jump through and you can pass the information on to your surgeon to help insure a complete submission to Aetna and a speedy approval!!!!  Best of wishes to you. 

I have seen on their website something about proving that you have been morbidly obese for 5 years before they will approve you. I dont  go to the doctor alot so I have no idea how I could prove that. Thanks for the suggestion though.

That might be a big hoop for you. I had to provide ONE medical record for each of the five years to show MO!!! I don't know what they would accept for that if you didn't go to a doctor during that time. I'd call them and ask what "proof" would be acceptable!!  Wishing you the very best.  Laurie

I have Aetna PPO too.  The guidelines for Aetna are The one for Obesity surgery #0157.    Try  googling it  as Aetna clinical policy bulletins.   I also called the insurance directly to make sure my employer didn't exclude WLS specifically.  My surgeons office did this as well before I went in for my consult.  I have been denied on my first submittal because of not being morbidly obese for five years.  One of those years I dropped to just obese (lose gain cycle).  I have recently been diagnosed with sleep apnea so at least I have one of the three co-morbidities they list.   I am trying for the LapBand.  I just got word Thursday that ObesityLaw.com is taking on my appeal.    I had heard from people at the seminar I watched and on these boards how surprising it can be that this may take longer than you thought.  I was really depressed at first but now I think it is helping me to be mentally better prepared if do get approved. 

Good Luck, MileHigh

I have Aetna EPO.  I am awaiting approval.  I had to do three months supervised weight loss, provide 5 years proof of MO (doctor's records), and, since my BMI is not quite 40, I had to provide proof of co-morbidities.  I'll let you know when I hear from my surgeon's office about approval or denial.  Should be any day now.