OUT OF POCKET COST WITH AETNA

Can anyone that has aetna tell me their out of pocket cost for the VSG or Bypass? I'm trying to get an estimate of what my out of pocket could possible cost so that I can prepare and have everything ready.  Also how long did it take Aetna to send your approval.  I'm hoping to have surgery at least by the end of march and my last nutrition visit is Feb 22...Any feedback would be helpful.

Thanks,
 

Hi,

My out of pocket was approximately $1,800.  We have a specific percentage of out the of pocket cap.  So for example, my out of pocket caps out at 3% out my base salary.  So last year when all three of my kids had WLS  in the same year, I paid the $1880 out of pocket on my daughter.  Then when it was my son's surgeries in Dec, since I had already met my maximum out of pocket, I only had to pay each of their $500 deductible and the rest was covered. 

You probrably have a deductible, then a maximum out of pocket you have to pay. 

All four of us (myself and my three kids) were approved by Aetna.  for my sons, they were approved within 2 weeks.  For myself and my daughter, we were denied at first, I filed appeals, and then it took about 30 days from the time they received the appeal to get the approval.

Are you doing the 3 month multidisciplinary program or the 6 month supervised diet?

Good Luck to you!

Nan

 

 

I am in the 3 month multidisiplinary program.  My last visit will be on the 22nd ive already done my psyc evaluation and my previous dr sent over my weight loss history so I should be good thats all they told me they required i feel like i need more but the insurance coordinator said im fine i just dont want to be denied for something I could have avoided.

Have you seen a dietician at all?  For the 3 month md program we were required to see a registered dietician. That has to be documented in the office visit notes of your physician that you have seen the dietician.  Three of us did the 3 mo MD program and my one son did the 6 month route. 

Good Luck, sounds like you are very close to getting approve!

Yes, the appointment I have on the 22nd is my last visit with the dietician.  Thanks I am really looking forward to getting this done it has been a long time coming.  Which procedures did each of you have?

We all had the RNY.  I had surgery in March 2009 and lost 160 lbs.  My daughter in May 2010 and has lost 107 lbs and my two sons had surgery on the same day in December 2010 and have each lost over 80 lbs so far!

WOW!! Thats great I hope I have as much success as you all I am having the VSG!! Thanks for all your help this information was really helpful.

It depends on your plan.  I have Aetna and my out of pocket will be $5000.  I hope to God yours will be less.