Question:
Has anyone had wls approved with Aetna Choice POS II policy?

How long did it take for the approval with aenta? Are they difficult? My BMI is 41.5 and i am worried they won't find that necessary. Help!!!    — Kristiemo99 (posted on June 24, 2008)

June 24, 2008
Just a quick note. Most WLS is approved by insurance companies for folks with a BMI of 40 or greater.
   — jujuprof

June 24, 2008
I have Aetna POS open plan and they paid for mine. Call your insurance and ask them. It was in our handbook that they paid so I already knew they would but I called just to doubt check before I ever started thinking about surgery. Good Luck and I wish you the best. Debi
   — DEBI R.

June 24, 2008
I forgot to mention my BMI was alot higher and I had skeep apnea but that was the only problems I had besides GERD. I had to do the 6 month weigh ins and attend support group meetings.
   — DEBI R.

June 24, 2008

   — Captain-Kirk

June 25, 2008
After 6 months of supervised weight loss and nutritional counseling I was approved through Aetna with a BMI of 40.5. I was 100 lbs overweight and also had one comorbidity (sleep apnea). Aetna and most insurnace companies require a medical necessity in addition to the obesity. In conjunction with my surgeon's office staff (who were amazing and do have sharp pens) I was able to get all of the documemntation together. I was very vigilant in making sure that I crossed every T and dotted every I and I read and re-read the Aetna policy bulletin to make certain that I met all of the criteria necessary. I started the process last July when I first went to a WLS presentation and Q & A and over the course of the summer last year I kept my diet and exercise logs, made sure I had medical records supporting my sleep apnea, consistent weight gain, fibromyalgia, depression, etc. I needed a recommendation from my PCP which was like pulling teeth but once I got that we sent in my paperwork and in 5 days I was approved. I was completely and utterly shocked! It may not be this easy for everyone, I am not sure----I was certain that I would be denied and have to appeal but for some reason, I got lucky because my application sailed right through. We sent my paperwork to Aetna on or about Novenber 6th and I was approved on November 11th 2007 and had my RNY/GB surgery on December 12, 2007. I am glad it worked out because if I had not been approved I would have had to start all over with a new insurance company. I wish you the best with this process. I found Aetna to be very helpful especially once I was approved as well as after the surgery with medical and weight loss support. Just make sure you are very thorough and meet all of their requirements and you should be good to go! If your surgeons staff is not super pro-active in helping you with the approval process make sure you keep after them. There should be someone in the office that works closely with insurance companies and they need to be your best friend.
   — ChelleBelle

June 25, 2008
I had no issues with Aetna. When I had finally made my decision to have wls, my surgeon's office said that Aetna required that I work with a dietician and a physical therapist for 3 months. They gave me the names of the two I worked with. I had to keep a food journal and a excercise schedule. Time went by so fast. After I completed the 3 months, my dietician submitted all of my paperwork and all we had to do was wait. I was approved, but Aetna had my paperwork sitting on someones desk and it delayed my surgery for a couple of weeks. Everyone else that was submitted was approved and ready to roll in less than a month. I was glad to have those 3 months, it taught me alot and gave me time to practice my new eating habits and not drinking with my meals. In October it will be 1 year. This was the best thing I have ever done. Any other questions, let me know.
   — Robin N.

June 25, 2008
I have Aetna. The good thing about it is Aetna is pretty up front about how they go by approving. They had two tiers of approval. The first tier, if you met all the requirements, did not include the 6 months of supervisoed visits. The second did. So for me, with the 6 months, it took me exactly 1 year from my initial consultation to my scheduled surgery date. The year was frustrating and the approval process was slightly frustrating for me. Aetna, in my case, used the full 30 days to review my request and then asked for supporting documentation AFTER the thirty days were up. I called and spoke to one of the agents responsible for pre cert and she actually sent my information to the directior. He approved, though. So even though I was angry and frustrated it worked ou in the end. Visit Aetna.com and look at the requirements. They are pretty good about it unless your employer excludes the surgery.
   — B. Jones