Re: Newbie--seeking Aetna OpenChoicePPO feedback

[Guest guest]

Hi Janis and welcome!

I don't know anything about Aetna PPO, but I do know PPO plans are

more likely to approve the procedure.

Something to consider is that if they give you grief and say they'll

approve you for the RNY, you can potentially pay the difference in

procedural costs as Hull has done (look for any posts by -

he's a wealth of information).

As for Dr. Jossart, he's great! I have surgery scheduled with him

for 12/5 and am really looking forward to it!

Cheers,

Amy S.

Pre-op

12/5/01

Jossart

> Greetings to all!

>

> This is my first post to this messageboard, as I am awaiting my

first consult with Dr. Jossart which is later this week. First, I

> would like to thank everyone for sharing their personal experiences

and thoughts in this forum...this has been a GREAT resource for

> me as I begin my journey!!

>

> I was wondering if anyone has had experience with the Aetna

OpenChoice PPO, which I have learned currently DOES approve the RNY

> surgery for qualified candidates, but as of yet, does NOT approve

the Duodenal Switch.

>

> Has anyone heard of anyone getting approved for the DS through

Aetna?(PPO or otherwise?). I would also be interested to hear of

> any other experiences or info regarding Aetna, as well.

>

> Good luck to all, and THANKS AGAIN for sharing!

>

> --Janis

[Guest guest]

Hi Janis,

I am not familiar with your insurance, but I wanted to invite you to

join Dr. Jossarts message board. I will be having my surgery, gulp,

next week and am so excited/nervous/excited/nervous! Smiles. I know

you will love Dr. J...he's just a doll!

http://groups.yahoo.com/group/DS_Jossart

Nice to meet you,

Theresa

pre op 11-19-01

Dr. jossart

> Greetings to all!

>

> This is my first post to this messageboard, as I am awaiting my

first consult with Dr. Jossart which is later this week. First, I

> would like to thank everyone for sharing their personal experiences

and thoughts in this forum...this has been a GREAT resource for

> me as I begin my journey!!

>

> I was wondering if anyone has had experience with the Aetna

OpenChoice PPO, which I have learned currently DOES approve the RNY

> surgery for qualified candidates, but as of yet, does NOT approve

the Duodenal Switch.

>

> Has anyone heard of anyone getting approved for the DS through

Aetna?(PPO or otherwise?). I would also be interested to hear of

> any other experiences or info regarding Aetna, as well.

>

> Good luck to all, and THANKS AGAIN for sharing!

>

> --Janis

[Guest guest]

Hi Janice and welcome. If you subscribe to

DS-Insurance_Authorization_Problems

(also a yahoo list) you will find lots of documentation that

Hull put together for a DS through Aetna. I don't know

if your plan differs but I would imagine all Aetna plans

flatly refuse to cover DS. However, managed to have

his DS approved but had to pay a chunk of it himself. If you

go back through the archive of messages for that list you

can follow his progress and look in the files that belong to

that list where there are appeal letters etc. He is the only

one SO FAR ))))) who has been approved.

I'm going to be fighting that same battle soon because my

Aetna coverage begins on Dec. 01.

I tried to get an appt w/ Dr. Jossart and was told that he

doesn't accept patients with Aetna so I tentatively made an

appt with Dr. Rabkin. Did you mention your insurance when

you made your appt w/ Jossart?

Good luck. Please keep us posted and again, welcome.

Jean.

Newbie--seeking Aetna

OpenChoicePPO feedback

> Greetings to all!

>

> This is my first post to this messageboard, as I am

awaiting my first consult with Dr. Jossart which is later

this week. First, I

> would like to thank everyone for sharing their personal

experiences and thoughts in this forum...this has been a

GREAT resource for

> me as I begin my journey!!

>

> I was wondering if anyone has had experience with the

Aetna OpenChoice PPO, which I have learned currently DOES

approve the RNY

> surgery for qualified candidates, but as of yet, does NOT

approve the Duodenal Switch.

>

> Has anyone heard of anyone getting approved for the DS

through Aetna?(PPO or otherwise?). I would also be

interested to hear of

> any other experiences or info regarding Aetna, as well.

>

> Good luck to all, and THANKS AGAIN for sharing!

>

> --Janis

>

>

>

>

> ----------------------------------------------------------

------------

>

[Guest guest]

oops, sorry!! Apologies to you for talking about you

when you're right here on this list. lol!! I'm on way too

many lists for my little brain.

Jean.

Newbie--seeking Aetna

> OpenChoicePPO feedback

>

>

> > Greetings to all!

> >

> > This is my first post to this messageboard, as I am

> awaiting my first consult with Dr. Jossart which is later

> this week. First, I

> > would like to thank everyone for sharing their personal

> experiences and thoughts in this forum...this has been a

> GREAT resource for

> > me as I begin my journey!!

> >

> > I was wondering if anyone has had experience with the

> Aetna OpenChoice PPO, which I have learned currently DOES

> approve the RNY

> > surgery for qualified candidates, but as of yet, does

NOT

> approve the Duodenal Switch.

> >

> > Has anyone heard of anyone getting approved for the DS

> through Aetna?(PPO or otherwise?). I would also be

> interested to hear of

> > any other experiences or info regarding Aetna, as well.

> >

> > Good luck to all, and THANKS AGAIN for sharing!

> >

> > --Janis

> >

> >

> >

> >

>

> ----------------------------------------------------------

> ------------

> >

[Guest guest]

Janis,

I have Aetna OpenChoice PPO and was able to get partial coverage.

They will approve a " distal gastric bypass " but will not cover

the " duodenal switch " . What end up hapening is that I had to pay for

the gastrectomy (about $2600) and they paid for the charge for a

distal RNY. They also covered the hospital costs. For some reason

they also denied the cost of a J-tube insertion and appendix removal.

My surgeon has appealed, and I expect to find out next week their

response.

Hull

> Greetings to all!

>

> This is my first post to this messageboard, as I am awaiting my

first consult with Dr. Jossart which is later this week. First, I

> would like to thank everyone for sharing their personal experiences

and thoughts in this forum...this has been a GREAT resource for

> me as I begin my journey!!

>

> I was wondering if anyone has had experience with the Aetna

OpenChoice PPO, which I have learned currently DOES approve the RNY

> surgery for qualified candidates, but as of yet, does NOT approve

the Duodenal Switch.

>

> Has anyone heard of anyone getting approved for the DS through

Aetna?(PPO or otherwise?). I would also be interested to hear of

> any other experiences or info regarding Aetna, as well.

>

> Good luck to all, and THANKS AGAIN for sharing!

>

> --Janis