Hurry up and wait... AETNA

Hello everyone,

 

I'm currently waiting for my paperwork to be submitted for insurance approval! It technically could have been submitted nearly two weeks ago, but my primary care doctor didn't want to write the letter of medical necessity until we received the results of a sleep study, which, by the way, revealed that I have sleep apnea.  Now that we have the results, I'm hoping he will write the letter and my paperwork will be submitted by mid week!!

I have several questions. Does anyone have Aetna and, if so, how long did it take to get a response from them once your paperwork was submitted? Did they give you a hard time and deny the claim initally? Also, what protein shakes do you drink and what are the total calories, carbs, and protein in them? Thanks so much for your help!

 

Jess

 

I have Aetna and was approved based on a BMI of 42 and sleep apnea. I had to do a 3-6 month diet trial that included documented monthly weights. My husband was denied by Aetna because his BMI was not over 40 for 2 yrs (documented) and he doesn't have any comorbids.
Protein shakes.... The Bain of my existence!!!!!! I use unjury and have tried several but dislike most all.

Thanks!! I've already completed the diet :) I'm so excited and can't wait to get a response!!

If I remember right, it took me about 1-1.5 weeks. Good luck! They denied my husband in 3days so maybe a longer wait is good?!?

I found Aetna to be extremely quick to approve.  Now they do require 4 months of nutritional counseling and for you not to gain any weight during that period or they may require that you do additional nutritional counseling or some other medically supervised weight loss program prior to approval.  However in my experience, I did the psychological counseling and the nutritional counseling that is 4 sessions that must be 30 days apart, my bariatric surgeon submitted everything exactly 2 weeks after the last nutrition counseling session and within three weeks I was approved.  I got notice of approval from Aetna the first week in November and I scheduled my surgery for early December.  

Thank you!! According to my surgery center, one of the options with my insurance plan was a three month doctor and nutritionist supervised diet, which i did.  I actually scheduled an appointment for next month as well and I've learned so much from the NUT, I plan to continue seeing her after the surgery :)

 

I'm also waiting to submit to my Aetna insurance... I've completed all my surgeons requirements so far including 4mos of physican supervised weight loss, physican Asst. meeting, nutritionist, pshyc exam, support meetings, meeting with OB and gastro due to past anemia issue and most recently having an ultrasound for gallstones... Praying I can get a date and submit to insurance in the next few weeks.. it seems like there is always some sort of hold up!

Good luck!! Hopefully it all works out and we can have our surgeries at the same time!

 

Jess,
Don't get discouraged if it takes a while. My husband had just gone through diabetic education so that counted towards his nutritional counseling. His was submitted 1st. He had a BMI of over 40 with 4 comorbidities. They first came back & wanted 2 yrs. worth of weights & failed diet attempts before approval. Then they approved him after about a month. When mine was submitted the dr. Office submitted everything they did for my husband. I had a BMI of 36.1 with 3 comorbidities. It took a month & they approved mine as well. Hang in there. It just takes time. I was sweating bullets. We wanted them done before the end of the year so we would meet our out of pocket medical expense for only one year. Mine was Nov. 27th. A 5 month ordeal.

Thank you Sharla! I appreciate the information. I will try to be patient, but its definitely not one of my strong suites lol!