Question:
has anyone been approved recently with aetna pos II in NY? How?

I live on Long Island and am very scared i will be denied because my bmi is just barely 40 and i have no major health problems but i will go for it. Also what is the difference between the 3 month program and the 6 month?    — longislandamy (posted on December 1, 2006)

December 1, 2006
Amy: I was just about 40 BMI and my insurance company covered me. My situation is that I am 61 and on cholestrol and blood pressure meds. No other problems. I had LapBand surgery on November 21st and doing okay. I don't know what a 3 month and 6 month plan are. I have never heard this. That doesn't mean they don't exist. Good Luck
   — janddhager

December 2, 2006
Thanks Diane. My insurance co. says i have to participate in a 6 month supervised diet and exercise program or a 3 month surgery study type program completed. Not sure how to go about that.
   — longislandamy

December 2, 2006
Amy, most Dr. associated with a hospital and staff can guide you in the different programs. Have you chose a physican????
   — janddhager

December 2, 2006
I have a doctor, but i know that most insurance companies will try to find any loop hole in order to deny the approval for surgery. I also heard that Aetna only approves about 70% of requests and i am sure many of those were because of appeals. I just really want this and don't want to be crushed if i am denied.
   — longislandamy

December 2, 2006
Amy, I think the difference is the 3 month program is comprehensive- with the nutrition classes, and everything rolled into one as in a program offered through your surgeon. The 6 month thing (I had to do that), is where you go to a physician, or nutritionist once a month for every month and they discuss diet/exercise with you. You cant miss a month and must discuss both aspects at around the same time every month. The dr will discuss with you your eating habits, exercise, etc and may prescribe weight loss meds, or they may just sugget a diet plan with you. Mine suggested lean protein, low carb ,, low fat and exercise. THat worked for me and i just went to the last appt. I will submit to ins next weeek. ANgela
   — A Q.

December 2, 2006
Thanks Angela good luck!
   — longislandamy

December 29, 2006
Amy, I have the same plan in KY. It was explained to me that the 5 years of medical history (to prove long term obesity) have become quite a sticking point for Aetna. Can you tell me if you've moved forward in your process? Good Luck.... Steve
   — Everythingeater

December 29, 2006
Hi steve, My appointment with the doctor is January 10th but i don't want to go through six months of weigh ins only to be denied. I am seriously considering having the lap band done in Mexico by Dr. Ortiz and just paying myself. I have asked my company over and over again if we have an exclusion policy but no one has any idea what i am talking about. That would be really great to know before i waste my time trying to get approved. Any advise would be greatly appreciated!
   — longislandamy