Aetna pos Nj

Hi wanted to know any info on Aetna and revisions- and if anyone here is having any issues with them - Jo

Hi  I am just starting the process  to have a revision , I ahppen to be new to Aetna this year - I called and they sent me  about 30 pages  of info.. comes down to a few things, 1. high bmi 2, if pouch is extended,3 co morbidities  I am doing my upper GI this week to see how large my pouch is - then maybe we can submit for approval ??   please keep 2 fingers crossed  Best to call them and have some info sent out to you .

THANK YOU - I CALLED AND HAD THEM SEND ME THE INFO - I WILL LOOK ONLINE TO FIND A DR IN MY NETWORK TO DO THE UPPER GI

I 2 have Aetna and their specific qualifications for a revision are pretty cut and dry...you have to be very careful with them, the post guidelines and fail to abide by them. This happened when I was trying to get approved for my RYN in 04.....straight from their clinial bulitin it states this....

1. Repeat Bariatric Surgery:
2. Aetna considers medically necessary surgery to correct complications from bariatric surgery, such as obstruction or stricture.
3. Aetna considers repeat bariatric surgery medically necessary for members whose initial bariatric surgery was medically necessary (i.e., who met medical necessity criteria for their initial bariatric surgery), and who meet either of the following medical necessity criteria:
4. Conversion to a RYGB or BPD/DS may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure; or

5. Revision of a primary bariatric surgery procedure that has failed due to dilation of the gastric pouch is considered medically necessary if the primary procedure was successful in inducing weight loss prior to the pouch dilation, and the member has been compliant with a prescribed nutrition and exercise program following the procedure.

So best of luck....I just restarted my revision journey...had my blood work done today, Endoscopy Monday morning, and Upper GI on Thursday....I'm keeping my fingers crossed...Keep me updated or share any info you get and I will be sure to do the same Christine

Hi Christine, Can you let me know how it goes with getting approval from Aetna? Im starting a new job and I think it says in general that bariatric surgery is excluded, but Im not certain. 

How did it turn out for you with Aetna? I am about to begin the appeal process. DId you have to appeal and if so any suggestions?

i see it' sbeen  while since you went through this with Aetna. How did it turn out? I have referrals from my doctor that it is medically necessry to prevent major pelvic surgey. At this point they have denied me. I plan to call and write starting tomorrow to begin appeal process. Did you hve to appeal and if so any suggestions on what to include in the letter?

My doctor is submitting my packet this week to Aetna for revision approval. I will let you know how it goes!!

How did it turn out for you with Aetna? I am bout to begin the appeal process. DId you have to appeal and if so any suggestions?

Thank you ladies so much - to be honest I haven't gotten on a scale in like 6 months because I know that I have gained - at my highest i was at 319 and never under 200 - my husband is in his journey for lap band so i am helping him get his stuff together  - question - what step did you do first - did you get an upper GI and then see a surgeon please any info will be greatly appreciated