Aenta Insurance

Hi everyone,
I have a questions has any one had a revision from lapband to RYN and covered by Aetna insurnce. Did you have a hard time having it approved.

I would like to hear the answer to this one. I started my revision adventure yesterday!


I am at 36 BMI after my 3.5 year LB travels... I was down to 30 bmi then 2 slips... so I don't know if they will approve.

Hello
My band slipped and had to be removed.  I didn't have any problems getting approved by AETNA for the revision.  In fact, they had me approved the same day that they received the letter from the Surgeon's office.

Hope that helps.

I have a lapband and am hoping to revise to DS.  I've just started my three months multidisciplinary visits, etc.  Here's what Aetna's guidelines (for my policy) required for revisions:

1. Repeat Bariatric Surgery:
2. Aetna considers medically necessary surgery to correct complications from bariatric surgery, such as obstruction, stricture, erosion, or band slippage.
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; or

6. Replacement of an adjustable band due to complications (e.g., port leakage, slippage) that cannot be corrected with band manipulation or adjustments.
   
   Hope this helps.

thank you for all your reponds they have been very helpful

I have been waiting almost 30 days for a response from the insurance. I was told today they should know this week..

Wahoo Aetna came through with my revision. 100% But 700 deductible.