Question:
HI..I just got on my new insurance through my employer, I am

in desperate need of this surgery. THe insurance plan I have is Aetna PPo OPen CHoice..NOw I know with this insurance I dont need any referrals, I am however wondering what the approval chances are for someone with only 1 dr supervised diet. I have many co-morbs 5,9..399lbs..I just wanna know if I am in for a log fight with the insurance co. also do I have to be on this insurance for any period of time before they would approve such an expensive surgery?    — [Anonymous] (posted on September 17, 2001)

September 17, 2001
I also have Aetna, US Healthcare Open Choice, PPO. If your BMI is 40 or greater and you provide some sort of history of weight lose attempts, they will not require a Doctor supervised weight lose attempt/diet. I did not have any Doctor superivised diet, with the exception of Phenn-Fenn, and I was approved within 3 weeks of my doctors office submitting the request. You shouldn't have any problems getting approved and I am not aware of any policy requiring you to be on the plan for a certain amount of time before you can use it. Once you are eligible for one part of your policy you are eligible for all of it. Hope this helps and Good Luck!
   — Susan M.

September 17, 2001
I also have Aetna, US Healthcare Open Choice, PPO. If your BMI is 40 or greater and you provide some sort of history of weight lose attempts, they will not require a Doctor supervised weight lose attempt/diet. I did not have any Doctor superivised diet, with the exception of Phenn-Fenn, and I was approved within 3 weeks of my doctors office submitting the request. You shouldn't have any problems getting approved and I am not aware of any policy requiring you to be on the plan for a certain amount of time before you can use it. Once you are eligible for one part of your policy you are eligible for all of it. Hope this helps and Good Luck!
   — Susan M.

September 17, 2001
I have Aetna US Healthcare Open Choice PPO. I was just denied because I had documentation of only one failed physician-supervised weight loss attempt. Today I called the reviewer and asked how many failed attempts I needed to produce and she couldn't/wouldn't answer the question. I then asked specifically for details in a written denial. I know other people who have the same coverage through Aetna who have been approved without this documentation, so I hope you are luckier than I am. I will keep my fingers crossed for you.
   — Benita W.

September 17, 2001
Insurance is not my field, but I've been in support groups for years, so some unofficial tips. Most want to see 5 yrs of attempts. I could easily track back to, well, a long time ago! Doctor supervised can include ANY time the doctor handed you a diet and said : do this. That was easy, as every doc I've ever seen has said that. And of course, I would try them all, only to lose & regain. I could not get exact dates, but Jan 89 to Jun 89 is a good approximate, for example. My WLS was 1994, so they asked us to track backward. Date start, type of diet, wt lost, date end, wt regain. And of course, between all the doc types were the self-induced, magazine & book diets. I had 2 pages! I do not have Aetna, but if you that detailed, they certainly cannot use THAT one. It helps if you have receipts or cancelled checks from any programs you were in, too.
   — vitalady

September 17, 2001
I also have Aetna Open Choice PPO. I have spoken to many different employees from Aetna--all have a different story. What you need to do is call them often and provide too much information, ie...weight loss attempts, steady dr appointments over the past 5 or so years, remember, being on a diet or weight reduction program and checking in with your dr counts as 'dr supervised.' If you joined a gym and mentioned it to your dr, that counts! You need to be persistant, call them often, fax papers to whoever they tell you to, fax them often and call to make sure they receive your faxes. I have not been approved but I haven't seen my surgeon yet, won't until next month! I do not know of anyone who has been denied by Aetna--they're have one of the highest approval rates! Good luck! Check my profile for my updates! Hope this helps!!!!!!!! Jennifer
   — jenn2002

September 17, 2001
I had Aetna at one time and was denied without at least two 12 week failed dr supervised diets. My dotor's office told me they were the hardest to deal with out of all the insurance companies that they used. If you have supervised diets you should get approved. They are just very strict. You might want to start a diet now while you are waiting to see a doctor so you have at least two supervised diets. Hopefully they have eased up since I tried to get approval through them.
   — Michelle Y.