Question:
Is is hard to get approval through Aetna HMO?

people that have had surgeryor been approved inthe last 2-3 weeks. My surgeons nurse said I wil need actualcopies of my med. chart. My PCP wrote a letter, Ive been on all the diet drugs Fen-phen, Redux and Merida. My BMI is 43 w/ about 8 co-morbids. The problem is the chart dates back to 1997, do you think this will be a problem w/ Aetna HMO? I thot' Aetna was one of the easiest ins. co. but my nurese says they are getting very ridged/strict about who they will do WLS for. I would like to hear from any HMO (Aetna)and your experiences in the past 2-3 weeks, I'm getting sooo worried now! Thanks    — Cindee A. (posted on October 21, 2001)

October 21, 2001
I got approved through Aetna HMO two weeks ago. I provided my diet history from age ten, including all doctor supervised, informal (self) diets and formal plans (weight watchers, etc.), drugs, etc. It showed an entire lifetime of diet attempts. Most of my doctor supervised were prior to '97 as well. They do require a BMI over 40 and comorbidities. That is Aetna's policy. I would provide the same type of history if I were you. It is better than doing it as part of an appeal.GOOD LUCK!!! My PCP told me Aetna always turned down his other patients. I was approved within one week. Aetna has many different programs. Your employer may have Aetna, but may have an exclusion for this surgery in their version of the plan. Or you may have a plan like mine... GOOD LUCK!!!!
   — Julie S.

October 21, 2001
I have Aetna HMO as well. I was sure i would have problems. As long as you meet the criteria you should do fine. Take a look at their website and search for gastric bypass or weight loss surgery. It explains everything. Make sure you have a well written out previous diet history, they will require some proof of previous doctor monitored/prescribed diet. As long as your surgeon is experienced and sends out a good letter, you'll be fine. It took me about 2 weeks for approval.
   — Lori Z.