Question:
AETNA INSURANCE APPROVAL

Ok...here is the deal. I have Aetna HMO, I know I meet all the criteria and have my LOMN from my PCP. She listed the various methods I have used to lose weight 'over the years'. She did not single out the last two years, I have written my own letter and included a 6 year diet history. Will it be ok since I included a specific history, or does my PCP have to specify?    — Shanchel (posted on August 6, 2002)

August 6, 2002
Who knows? Some people get approved with Aetna with no problem while others (like me) do not. From what I can see, Aetna USED to be one of the easiest companies to get an approval out of. Then sometime within the last 6 months or so, they just got tired of paying for this operation and are denying people who clearly qualify, refusing to allow any further appeals, telling you that you can only leave a message on voicemail for the appeals committee (and they never call you back), etc. Again, you might breeze through like a warm summer day, but it's not as guarenteed anymore. My best advice is to throw EVERY shred of documentation at them now. It can only help.
   — Tired P.

August 6, 2002
I am 12 weeks post op and Aetna approved my surgery within 3 days of submitting the first request. My surgeon's office sent them a copy of my medical records from my PCP, a copy of a diet history that I composed and a copy of my sleep study which documented that I have sleep apnea. I was on Phen-fen for about 9 months and my medical records reflected several diet attempts, but for the most part, a majority of my diet attempts were not under the supervison of a physician. My sister and I had our surgeries on the same day, same insurance, same diagnoses, and she was also approved within 3 days. If you'd like further info feel free to email me direct. Good luck!
   — Traci A.

August 9, 2002
I have Aetna HMO and did my homework. Had PCP send my records for past 5 years (not much weight loss other than diabetic diet) plus a letter from him, had letter from diet doc I went to last year that failed, and typed a letter out regarding treatment from diet doc attending the past couple months as his office was not open when Aetna needed the info. I was approved in less than 7 days. I knew when the hearing was going to be and it was approved then. I got my tentative surgery date. I've been hearing that Aetna HMO gives the most approvals. Good luck to ya!
   — Laurene G.