Question:
Aetna Open choice PPO

Has anyone been approved the first time around with Aetna Open Choice PPO insurance in 2005? Thanks in advance for any answers. I appreciate it.    — maryg (posted on October 31, 2005)

October 31, 2005
Hi mary - congrats on your decision for WLS. I have Aetna Open Choice PPO. I had to do the 3 month multi-disciplinary plan due to not having 6 months of documented weight loss history in my file within the last 2 years. I had done weight watchers and other things - but hadn't told my DR about it. I had all the other stuff but just not that. So after I did that - I submitted all of the documentation to Aetna and was approved within 5 days. it was great. Do you have the document from them that lists all the requirements you have to have? It is document 152 I believe. IT is their requirement for covering WLS. GOod luck - don't hesitate to email me questions. [email protected]..
   — akirsch

October 31, 2005
You can find the policy at http://www.aetna.com/cpb/data/CPBA0157.html Aetna likes to remind folks that sometimes the employer chooses not to purchase certain benefits, make sue you check with the covering employer to see if they have excluded WLS. Good luck.
   — nursenut

October 31, 2005
I was approved in July using the 3 month program. I had my surgery Aug 8th. It took less than 24hours for my approval. Good Luck
   — *Malena* M.

October 31, 2005
It took forever to get approved and that was only after I filed a complaint with the dept. of insurance in Florida and they gave Aetna 15 days to answer why I was denied after I did all that they require and Aetna approved me on the 14th day.... So good luck
   — thelindersmom

November 1, 2005
I was approved by Aetna after two denials. Congratulations on taking this step. You won't regret. Once you get approved...the surgery happens before you know it. Good luck to you, and please feel free to email me with any questions. [email protected] 4 1/2 months post surgery and down 100 lbs....best thing I have ever done!!!!!
   — Tracee B.

November 2, 2005
I jumped through hoops for Atnea. My PCP wrote a letter to the insurance company and listed everything they wanted and more and still they never responded I called and called and the only thing I ever got was a person on a computer looking up if I had approval. You can never talk to anyone that makes up the so called medical board that says yes or no. I started the paperwork in January and finally had my surgery in July by paying for it myself. since the surgery they have paid for the surgeon all lab and pre-op work and the hospital bill is still pending because the hospital never submitted the bill untill sept 19th.( I am keeping my fingers crossed) I never recived anything from them saying yes or no. keep trying and if they say no and you self pay submit it anyway. but make sure your doctors office will submit it on your behalfi.I had to keep after them. alot of times if you self pay they give a cheaper rate and then they won't send it to your insurance. Thats why the hospital did not send it in until I called about a dozen times. Good Luck and keep trying it is so worth it. I had the lap-band and since July 18th I have lost 41lbs. I feel like a whole new person (or a 1/2 of a new person) cynthia
   — gurdy