How long for Aetna's insurance decision?

I have  Aetna.... Anyone have any idea how long it takes after submission for Aetna to make a decision?

AND I did the the 3 month "Fast Track" ... Anyone started with this and Aetna required them to go the extra 3 months?

If so, what was your final outcome?

Thanks so much in advance.

Hi,

I have Aetna as well as my three children.  All four of us have had bariatric surgery.  Three of us did the 3 mo MD program and my one son did the 6 month program (only because he needed to buy time since he wasn't 18 yet)  Two of us were denied at first and my two sons were approved right away.

With the approvals of my two sons, from the time it was submitted, it took about two weeks to hear back that they had been approved.

I was at first denied only because my paperwork was turned in too soon and I had not gone to my final physician visit.  so as soon as I completed the program, I appealed and it took about 3 weeks for them to overturn the denial. 

My daughter was also denied after going through the 3 month MD program.  I filed an appeal for her, and it took 27 days to hear back that the denial was overturned and she had been approved.

A word of caution...don't be discouraged IF you are denied.  I can help you with an appeal as I have had a lot of experience with Aetna and what the require with all four of us going through this.  They are very picky about meeting the requirments, but as long as you have done everything required of you, they will approve.

Did you see your PCP, a dietician, document behavior modification and exercise with your PCP, meet the requirements of the BMI, and submit your psych eval?  If so, you will have no trouble getting approved. 

I had my surgery in March 2009, my daughter in May 2010, and my two sons in Dec 2010.

Good Luck to you!

Nan

Thanks so much for your reply - and your encourangement!! I am excited and scared, but mostly excited! I am so ready to live again - to be healthy and active!

It will be a week on Monday, so it is very early.

Sounds like you have a ton of experience with Aetna and you have obviously been a great success!! Congrats!!!

Glad to be your friend!!

Angie

Angie,

Glad to be your friend too!   Let me know when you hear from Aetna!!!! 

I just read your blog on you profile where it gave the details of what you have been doing.  It sounds like you have been doing everything right and what is expected of you!!!!  The only thing that stuck out to me was that you started in March and submitted in June which is 3 months but was it 90 days apart??  From your first visit to your last vist has to be at least 90 days (180 if you are doing the 6 month program)

Just to be safe, if I were you, in case you already haven't, continue seeing your PCP so that you don't miss a visit during the approval process.  That way, if they come back saying you did not complete the 3 mo MD program because you are xxx many days short, you will have your July visit in. 

Just my thoughts......keep me posted on your approval!

Nan

I have AETNA, and worked closely with the insurance coordinator at my surgeon's office.  She indicated that AETNA usually responds very quickly - within a week.   The three-month option is also OK as long as it is done with the nutritionist at the surgeon's office.  I'm going self-pay because I haven't had a consistent  BMI greater than 35 for two years. (I'm a yo-yo dieter)  The insurance coordinator states that AETNA is very picky about that unless your co-morbidities are quite severe. 

The clinical policy bulletin spells out all the requirements quite clearly, and it's available on the AETNA website.

Good Luck

 Hi! This is my first post (be gentle! haha).

I'm looking into all of my options at this point but I've narrowed it down to either the sleeve or banding.

I also have Aetna and trying to figure out options there as well. How long is the process usually from the first information class to having the surgery (using the 3 month track)?

Also, what exactly IS the 3 month track? I've had Aetna supply me the details but I guess I would like to hear from people who've done it already.

I haven't had an official weight loss program although I have been on weigh****chers for years. I have a BMI of about 41 and High Blood Pressure for about 3 years (just had to start medication this year).

Is it remotely possible to have it done by the end of the year? I usually wouldn't be in such a rush but I've already hit the max out of pocket for this year due to the birth of my son in February. So, financially, it would make more sense to have it done this calendar year, know what I mean?

Thanks to everyone!!! :) 

I am a federal employee w/ Aetna.  Currentlly we are doing battle because like Eliza I have not had a consistent 35 or greater BMI for two years (of course, I've had co-morbidities for more like SIX years, but that doesn't seem to impress them). 

As far as the pre-op requirements, I did 3 visits each w/ a psychologist and a nutritionist.  Then, it was a 3 month supervised weight loss program with the surgeon himself.  After that, we submitted the paperwork.  It sounds like you would not have the BMI problems I am having, and w/ your hypertension history I'd think you have a good chance to getting Aetna's blessing the first time through.  However, they still may insist on the 3-month doctor supervised weight loss.  If you start it now, or even the first of August, you might be able to squeeze in by year's end -- depending of course on your surgeon's schedule. 

Good luck!