Aetna Review Timetable

Hi all,

I am in the final stages of the pre-op medical clearances required before my surgeons office submits the request for Aetna coverage. For those with Aetna, how long did it take them to review your case and respond! 

Any hints or suggestions to bolster the strength of the request?  My surgeons office will do the submitting but I just want to ensure I am doing everything I can from my end to make it a strong submission.  

Thanks!

christine

I had Aetna. I followed the guidelines exactly and when my surgeon submitted I waited a week and I called them. Now take into account this was 12 years ago, sure things change, but I was told I didn't have 'supervised' exercise program.' I swam daily for those 6 months. As it turns out a lady at the pool was an RN and she wrote a letter saying she saw me daily . I faxed the letter to them. Waited a week and called. I was approved !! Do not give up if denied best of luck it's worth fighting for!

Hi Christine,

I take it from your weight tracker that you must have gotten approved from Aetna. I just found out today from Aetna that I have been denied and that it's not covered. Was your WLS covered under your plan and if not what did you do to get approval?

Thanks,

Chris(cc583)

Sorry to have taken so long to reply! 

I did get my approval.  I followed every guideline to the letter and while it took them until the 11th hour (the day before surgery) to approve, I was in fact approved. 

Aetna's hesitation came from a mix-up in the submission;  my doctor's office had submitted with some incorrect dates and it looked like I hadn't done my full 4 months of pre-work.  When this was corrected, my doctor submitted an appeal to expedite approval so I could keep my surgery date.  

Did you find out why you were denied?  Do you seem to meet all the criteria (BMI, medically supervised diet, etc.)?  

Keep up the fight.  If WLS is the right decision for you, don't give up.  It has completely changed my life and I hope you'll find a way to get there.  

Best

Christine