I'M APPROVED W/ AETNA !!

Well, after my initial denial in April, I'm finally approved! Funny part is, I found out two weeks ago my secondary insurance agreed to cover the surgery 100% in-network anyhow, but I still had to wait for Aetna's decision to simplify things. Today, I received a letter stating: Dear Ms. XXXXXXXXXXX: Aetna Life Insurance Company (Aetna) is in receipt of a letter filed on your behalf by XXXXXXX of XXXXXXXXXXX requesting coverage for gastric bypass surgery (procedure code 43847). All of the submitted documentation pertaining to the above-mentioned request was reviewed by a physician who is board certified in general surgery. It was the determination of this physician to overturn the previous decision and to authorize coverage for gastric bypass surgery, procedure code 43847. This determination is based on the fact that with the new information submitted it is shown that your Body Mass Index is 40.5, you are 38 years old, you have attempted weight loss in the past without successful long term weight reduction, and you have recently completed the 3 month multi-disciplinary surgical preparatory program requirement as noted in Aetna Clinical Policy Bulletin #157 (Obesity Surgery), which was referenced for this determination. As such, you have met the criteria for gastric bypass surgery. WOO HOO!!! I will be having my surgery with Dr. Kaczmarski at Barix Clinics in Langhorne, PA. I will definitely be waiting to schedule until after the holidays though (my personal choice).

Congratulations on your approval date and and your continuing journey to becoming a big loser Your enthusiasm is encouraging. Sarah

Christine -- just a word to the wise -- you better check the fine print -- I believe Aetna's approval is only good for a certain amount of time - being 30-90 days. If you wait longer than that, they may not cover you again. Also, Aetna has decided that effective January 2005, they are not covering bypass surgery thru insurance unless your employer purchased a special rider for it -- of course, not many companies will do that. My colleague is going thru the same thing with Aetna right now, and has pushed to have her surgery during 2004 so she doesn't run into this problem. Before you wait too long, check out the fine print. In any case, congratulations. Lap Rny 6/16/03 -- 336 / 161 / 150

How right you are! I was scheduled for the 12 of Oct and had to reschedule till the 9th of Nov..the nurse at the doctors office had to get a new approval. and advised me that they aren't good for more then i believe 60 days but don't quote me it could be 30,,,,my point is that when u are approved u have to take a date that they give you eithin a time frame...good luck and congrats to Christine..~Lori.....

Hi Lori , I spoke with Aetna Member Services this morning who confirmed for me that my authorization is good for six months from the date of approval. They also confirmed that although the surgery may not be covered for SOME after 1/1/05, I am "grandfathered" in with my approval letter. I then spoke with my surgeon's office who also verified this with Aetna. They also told me that even if I couldn't have my surgery within the six month timeframe, they would simply call Aetna and request an extension, which is always granted. The only time we would have to refile is if I waited over a year. Just an FYI for anyone dealing with Aetna. Do not panic!

Hi Nannette! I just wanted to let you know that I spoke with Aetna Member Services this morning who confirmed for me that my authorization is good for six months from the date of approval. They also confirmed that although the surgery may not be covered for SOME after 1/1/05, I am "grandfathered" in with my approval letter. I then spoke with my surgeon's office who also verified this with Aetna. They also told me that even if I couldn't have my surgery within the six month timeframe, they would simply call Aetna and request an extension, which is always granted. The only time we would have to refile is if I waited over a year. Just an FYI for anyone dealing with Aetna. Do not panic!

Christine, CONGRATULATIONS!!!!! That is awsome news! I know you have called your insurance company to make sure of everything BUT I would get what they tell you in writing...it cant hurt to take that precaution. Insurances have been coming out with so many new laws regarding WLS. I would hate to see you lose your approval because of a loop hole! Lots of luck to you! ~Kristin p.s. I had my surgery right before the holidays (Dec 6, 2002)...I was well enought to travel and get around but I was glad I couldnt eat!! LOL