Submitted to Aetna Ins for Revision Surgery
This is a copy and paste from a different forum I was on - got no response. Seems to be a dead forum. Can anyone provide some insight. I think the revision will be denied.
~ Star
Post # 1
I am new to the forums. I will be sharing my story in a different forum later tonight. Right now I have a question for anyone who may have had a revision done to your gastric bypass. I followed Aetna's requirements:
- 90 Days with surgeon (weight management)
- Visit with nutritionist
- Visit with mental health provider
- Visit with a local exercise facility (3 visits prior to submissions)
- Chest x-rays, blood work, sleep study, and a few other items (cant think)
- write a personal letter
My surgeon's office was I believe submitting either last Friday or Monday. I successfully lost 6lbs during the 90 days (mostly water weight).
I was curious who got denied, or who got approved and how long did it take.
Thank you!
Post # 2
So, I got an email response from Aetna, can anyone provide some insight? To me it seems like they might deny it. I should also say my surgeon's office never contacted me for additional information. Should I be concerned.
Your request
Your precertification request, authorization number ########, is
pending.
On November 16, 2015 a letter was sent to the requesting provider stating we needed additional information to make a decision. We
requested the following information: Clinical documentation appropriate for the procedure, such as diagnosis, medical history and physical, symptoms, relevant medical chart records, results of appropriate imaging modality, results of conservative management, Photographs, functional assessment etc. Once our Precertification Department receives the additional information they will be able to make a determination.
