You CAN request in network authorization with Aetna

I had surgery over 3 years ago with Dr. Mehta.  Great doc.  You can't ask for anyone better, in my own opinion.  Over the past few years I have had complications, but he has handled them - strictures, hernia, appendicitis - you name it.  He is a great doc and a fantastic surgeon.  I am probably looking at getting my gallbladder out and he would be my surgeon (unless it was an emergency and I couldn't drive to New Brunswick.)   I feel great.  I just saw him last month for follow up care on bowel obstruction surgery (yeah, my body sucks - it just doesn't heal right!) but he has been right on everything - I trust him explicitly.  Personally, I don't care if he is out of network or whatever - I am very happy with everything he has done for me.  He recently, without WLS, operated on my sister for her gallbladder and she was very happy.  Feel free to contact me with any questions.  Good luck to you.  Kathy  (Oh, by the way, I am in the pamphlet that they give you - under Kathy S.  ------I got my surgery in less than 60 days -----unbelievable - my primary doc says that whenever he needs something in a hurry he will call on me.  Even he can't believe I managed (with Dr. Mehta's office staff) to get my surgery done that quickly!!!!!

Hi Kathy.....I didn't even realize you replied to my post, I just happened to be going through the NJ members list trolling for Dr Mehta's patients, and there you were. Im embarrassed to admit I chose Dr Mehta for sheer convenience as I work in New Brunswick, and that would make my follow ups easier. I have been reading post after post on this and the LapBand forum all weekend. Which surgery did you have? It's good for me to hear from other of his patients so I feel more informed about my choice. to be honest, my primary physician advised me against Dr Mehta because she doesn't  like that he advertises so much, she doesn't trust him. She suggested Dr Ballantine in Livingston I think, but that is so far from me.  Well........thank you for listening amd wish me luck as i wait for insurance (AETNA) approval. I wish you all the best and a speedy recovery with your gallbladder. Eileen

Hi Eileen, I had the LAP RNY.  Very uneventful surgery.  Back to work in 2 weeks.  I thought about the lapband but it was still experimental back then and we had Aetna HMO who said I had to stay in network, blah, blah, blah..........................so, I work for a very small company (5 employees) and I called my insurance agent and boo-hooed to him.  It turns out that in NJ you can opt out of the health plan offered and pick up something else.  So, after researching, Oxford Liberty was very generous with their plan and benefits.  So, I dropped off the Aenta plan, joined Oxford (my boss paid the premiums, but when I went off the plan, I paid them myself - it was only fair) and had the surgery.   When our Aenta plan came up, my boss switched everyone over to Oxford and started paying my premiums again.   Recently, though, I dropped Oxford because I got remarried and my hubby works for the state, so I am on his insurance. When is your appointment?  Lulu is a trip - you'll like her.  My primary likes Dr. Mehta alot.  Because of the health issues I've had, my primary and Dr. Mehta are in close contact.  My health issues have nothing to do with the surgery (ok, maybe the one time my potassium level got down too low and I spent a week in the hospital), its just the way my body heals - strictures, hernias, adhesions, bowel obstructions brought on by adhesions..........................Funny story - recently I had bowel obstruction surgery.  So, I'm in the hospital e-room, waiting to get admitted (been there like 10 hours already) and in unbelieveable pain.  The nurses were treating me like crap (and yes, I filed a complaint) but at around midnight, after waiting like 6 hours more and at least 3 hours since I had asked for the 10th time for my pain med, the nurse said "hold on".  Mind you she had said that the whole time.  So, I called Dr. Mehta on his personal cell phone number, complained and lo and behold, got some morphine in about 10 minutes.  The nurse was not happy.  I finally got moved to a room at about 4 am and had the surgery a few hours after that.  Came home the next day.

Good luck.  Feel free to ask me anything.  Kathy

 

 

I HAD GASTRIC BYPASS 11/6/06 I'M DOWN 90LBS. TRUST ME IF HE IS OUT OF NETWORK THEY WONT APPROVE IT. IF I CAN BE ANY HELP EMAIL ME [email protected] HARRIS

Eileen, I just checked at the American Society for Bariatric Surgery and you can do a zip code search for all bariatric professionals in your area.  The link is here:  http://www.asbs.org/html/about/membersearch2.html

EILEEN,  I WORK FOR MERIDIAN AT R\RIVERVIEW MEDICAL IN RED BANK, WE HAVE QUAL CARE PPO. THERE IS NOONE WITHIN THE THREE HOSPITALS DOING  THE GASTRIC OR LAP BANDS. SO QUAL CARE APPROVED FOR ME TO USE DR FRANK BORAO AT MONMOUTH MEDICAL AND PAYED FOR IN NETWORK COVERAGE. YOU ASK FOR UTILAZATION REVIEW AND THEY HAVE TO GIVE YOU A SURGEON IF MEDICALLY NECESSARY OR TELL THEY YOU WILL CALL THE INMSURANCE COMMISIONOR IN NJ. THEY HAVE TO STEP UP YOUR BENIFITS THEY DID MUINE AND DR BORAO IS WONDERFUL BY THE WAY! E MAIL ME IF YOU NEED ANY MORE INFORMATION GOD BLESS  JOYCE [email protected]

Hi Joyce,

They gave me 2 surgeons to check out, but one doesn't do the lapband, the one who does is 28 miles away, I think the limit is 30.  I really want to use the surgeon here in New Brunswick, I want to be close in case of emergency. Also, I heard that Aetna doesn't approve the lapband, and I really don't want a bypass. Im not gonna change my mind about that, so this whole thing might have to wait until next open season, (groan). Thanks so much for your suggestion, I will defininetly ask for that utilization review. Good Luck on your journey! Eileen