AETNA - Approved in 24 hours on 1st Submittal

I have Aetna Choice POS II and my employer covers bariatric surgery.  I read the boards and gathered all the info I could as it relates to their 3 month multi-disciplinary requirements.  Big shout out to Miss Missy.  Her sample monthly recap letters that I used to provide my pcp some assistance helped.  If the policy bulletin is followed to the letter.  No derivations. And, the documentation from all three sources (pcp, nutritionist, and exercise physiologist) details your participation and their support, there's no reason you shouldn't get approved.  If you are, be prepared to fight.  On top of that, I got all my labs and clearances, including a split night sleep study, completed in less than 3 weeks.  Here's my process recap.

August 2009 - Initial PCP/Nutritionist/EP visit

September 2009 - 1st Month of Program with PCP/Nutritionist/EP 
October 2009 -2nd Month of program with PCP/Nutritionist/EP
November 2009 - 3rd Month of program with PCP/Nutritionist/EP

December 2009 - Final vist with PCP. Letter written and submitted to Surgeon.

* notes and letters for each visit was written. Each source detailed my weight, bmi, blood pressure and stated accomplishments from previous visit and goals for next.

Insurance work was submited on Friday, 12/11.  Approval received today, 12/15.  Surgery schedule 12/23.

BTW: The policy bulletin requests 2  years of weights which is all I provded.

God is Good!!

I hope this post provides encouragement to those beginning their journey.  Let me know if you need anything from me to help.

CONGRATULATIONS on getting your approval!!

I too have Aetna insurance and I was approved after going through their 3 month multidisciplinary program!  I remember when I was going through the approval process I was reading everything I could get my hands on from these boards about Aetna and Miss Missy and Bama Mama and Bonnie all posted things and PM'd me their experiences so I knew exactly what I needed to do to document and meet the requirements. 

That was 9 1/2 months ago and I am down almost 140 lbs :-)  Good Luck with your upcoming surgery!!  You will have a great 2010 :-)

Hi,

You seem very organized, so I'm going to jump start from you if you don't mind.  First question:  Who & Where is Miss Missy?   Second:  So you had four consecutive months seeing all three each month Primary Care appointment,  Nutritionist appointment, and EP (what's EP).  What letters did you have the write? Can I get a copy?.  I'm pretty sure my specialist who deals with my stomach issues would help too.  How did you give them exact weights for the last 24 months... Did you give an educated guess?  Did you need doctors records to verify?

I want to use my time an co-payments wisely?  Meeting insurance criteria can be frustrating...  After the insurance paid, did you have any balance owing?

Thank you,    trustJesus

I don't know who or where Miss Missy is.  All I know is during the time I had surgery (2009), her post was very instrumental in helping me ensure approval with Aetna. EP stands for Exercise Physiologists. Yes, the four consecutive months are crucial.  You can view the first month as being the start of it all and the three consecutive months as your checkin.  I started in August and had my last appointment in November.  I ensured I went to a nutritionist and ep that were familiar with the bariatric surgery process.  I don't know where you're located but you should be able to find someone.  For the 2 years of weights I called all my doctors that I had seen during that time that I know had a weight for me.  I pulled from my OB/GYN, Primary Care Specialist, I even went to the corner diet doctor that I had gone to see to get a copy of my records.  I supplied all of those record copies to my physician and had her to write me up something.  Now mind you, I had to do some modification to the original letter , but needless to say, I got it done and was approved within 4 days on the initial submittal.  Had surgery 12/23/2009.  By me having it at the end of the year, I was able to take advantage of all the OOP limits for the year.  All in all I was OOP about $2500.  Email me if you can... ericabaity at gmail dot com.

 

Take care,

Erica

That's ericambaity at gmail dot com

Congrats! I'm so glad that you got your approval. Hang on and get ready for a ride that will change your life!

Bama.Mom/Miss Missy :)