Aetna approved now need dr.....

Hi there.  I was so happy today when my RNY Dr's office called and said Aetna approved my panniculectomy.  Then they called back and said it would be 3,000 out of pocket because Dr. is out of network and insurance only pays 50% and Dr. won't waive the other 50% like he did for my RNY.  ( Same doc does rny and plastics, beautiful work btw)  Anyhow, I just had a baby 2 months ago and have been on maternity leave and I can't afford that right now.  So I wonder should I take my approval elsewhere to someone in network???  If so who?  I have a list from Aetna.com of Dr.s in my area but I don't know if I can just take my approval somewhere else.  Can anybody recommend a ps Dr. in my area?  Or should I just make 100 dollar a month payments that they offered?  Is 3000 a good price?  His patients looked like fricken barbie in the pics when he was done.  Thank you for your help.
Lanie

I'm so happy for you Laneya! I'd go with the 100.00 per month it sounds like he's an awesome Dr. :)

Leaning that way I think :)

I am 2 years post DS, with my weight stablized for the past year.

Before my DS, I had considered and was approved for a Panniculectomy (msp) paid for by Humana.  This past year, insurance coverage was switched to Aetna and I have no idea what their procedure is for plastic surgery approval. 

Humana approved my procedure the same afternoon they received the request.  However, Aetna says it will take seven to ten days, and of course, requires medical necessity.

Could you help me with some info regarding your approval, i.e. the letter of medical necessity and Insurance Code that was used.  I would be deeply grateful if you could share the info with me by Private Message.  Thanks.

As for switching Surgeons after approval.  I did that when getting WLS and it worked smoothly.  Went to second surgeon and told them I was already approved.  Second surgeon contacted the insurance company and advised them that I was making the change in surgeon/not changing procedure.  The insurance company said "no problem".  It was just that smooth. 

Good luck to you.

In some areas, "in network" plastic surgeons are refusing to accept insurance for panniculectomy (saying it's cosmetic EVEN if you have it already approved by the insurance as medically necessary) just because what the PPO/HMO pays them for it is a pittance... so they won;t accept it and force thge pateint to pay then full amount up front and then have the insurance reimburse the PATIENT the pittance.

In other areas this does not appear to be a problem, but in my city there is not a single PS who accepts Athem OR Aetna who will do a panni under insurance, so I would call some of the Aetna doctors and ask thjem on the phone if they will accept it.  If they will, the Aetna apprpoval is good regardless of the surgeon.

Lora

Thank you for your help.  I will work on that Monday.  I am in California and there seems to be a lot of plastic surgeons on Aetna's website that are contracted with them.  Hopefully that increases my chances.
Lanie