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Postby meganhateswaiting » Tue Jan 12, 2010 1:22 pm

Any recent Aetna approvals? Also, if you have aetna coverage, what was your experience with them like and how long did it take for a decision on approval or denial?
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Re: Aetna?

Postby Modelgirl2009 » Tue Jan 12, 2010 5:10 pm

Hi I am getting a breast reduction and aetna approved they are paying 90% i pay 500.00 out of pocket (not to bad)... took about two weeks
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Re: Aetna?

Postby prettigurl07 » Wed Jan 13, 2010 5:44 pm

hi i got approved for aetna n i had my surgery yesterday..they also covered my surgery 90%.in my case it took more than two weeks because the first time they didnt approve me.but they did an appeal and i got approved.so in my case it took about 5 weeks.
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Re: Aetna?

Postby finallyac » Wed Jan 13, 2010 6:27 pm

Wow, I'm surprised you all had such success with Aetna. I had a breast reduction back in June 09. It took me nearly 10 months for approval. I was denied 3 times, then had to appeal to a board. The date I was supposed to have a conference call with the board, I was approved...I think they just wanted to weed out the people who weren't dedicated. I don't recall what percentage Aetna paid but I ended up paying $1200 out of pocket. If you do get denied keep after it, I had to show proof that I had seen a physical therapist, had taken muscle relaxers, and pain pills for longer than 3 months, and I also had a notes from: my general doctor, my plastic surgeon, my physical therapist, and my gyno.
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Re: Aetna?

Postby teachermomva » Tue Jan 19, 2010 6:19 pm

Hi Meg
I also have Aetna and was approved about 2 weeks after submitting info. I have great drs who had worked with BR patients in the past.
I will have my surgery this Thursday!
The only requirement is to have an AETNA approved surgeon , which wasn' t a problem in my area.
But for some this is an issue esp if their dr/surgeon does not deal with insurance.

My drs documented everything and things are all set! I will also have a tummy tuck Thur, that I will be paying out of pocket for ...

I am happy but a bit nervous about recovery .....
:| :D
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Re: Aetna?

Postby abrewer76 » Wed Jan 20, 2010 12:10 pm

Hi, I am in the process of appealing Aetna for breast reduction surgery. They have denied me because I don't meet the criteria of the CBP chart. Have any of you been approved for breast reduction that didn't meet this chart either? My plastic surgeron has recommended to remove 750mg of tissue and the chart aetna goes by recommends 1000mg. I have included letters from my ob/gyn and weigh loss charts and dozens of photos for shoulder grooves. Any other ideas? Thanks so much for any help!
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Re: Aetna?

Postby Stardog » Tue Feb 02, 2010 6:50 pm

Well it was in 2007 but Aetna paid for everything, except for my $175.00 copay. It took about 3 weeks for approval.
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Re: Aetna?

Postby Yuna » Sun Feb 07, 2010 10:22 pm

Well I have Aetna and they have provided me with a list of plastic surgeons in my area of Atlanta to check out that are their approved providers. I am going to research them all for and then next month in March make my appointment with them and hopefully be successful in picking one and hope to submit my paper work by April and having the surgery done no later than June 2010. They also have circumstances where they will also cover a tummy tuck and I will be trying to see if I qualify for that too. My insurance covers me 80% up to $2600 and after which I would be covered at 100% so initially I would have to pay my $1000 deductible and then a max of $1600 towards the cost of the surgery and they take care of the rest. I am super excited!
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Re: Aetna?

Postby vhoff192 » Thu Feb 18, 2010 7:31 pm

Hi, i am in the process of going about getting a reduction, does anyone have any recommendations for plastic surgeons in the Seattle area approved by aetna? I need to get an exam done first before i submit to aetna. Anything i should expect?
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Re: Aetna?

Postby andyromero » Tue Dec 18, 2012 7:42 pm

Hi, I live in Miami and am trying to get a breast reduction procedure with Aetna Choice II... what hospital perform this procedure under aetna? Covering 80%?
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Re: Aetna?

Postby sgray5401 » Thu Jul 10, 2014 8:39 pm

I know this says "recent" however I thought that since I'm still finding this site via google results in 2014- others may as well.

I had my first consult in Sept of 2013 and my surgeon submitted to Aetna - denied in about 3 weeks. They wanted more proof that it was a medical need, so I saw a chiro for a whole treatment plan which is 12 visits.

My surgeon submitted (for the second time) his proposal for taking out 500g from each along with notes from the Chiro that adjustments wouldn't stay in place because of the weight from my chest AND a letter from my primary physician describing pain complaints that I'd had, etc. That was denied in about 4 weeks. When I called to ask why, Aetna said thatI would need to remove at least 690g from each in order for them to cover it. I had another consult with my surgeon and he resubmitted paperwork proposing to take out 700g from each. The appeal was accepted and approved about 4 weeks later.

The surgery was quoted at close to $7000 and we ended up paying $1200 out of pocket.
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Re: Aetna?

Postby cnash » Fri Jun 26, 2015 10:46 am

sgray5401 wrote:I know this says "recent" however I thought that since I'm still finding this site via google results in 2014- others may as well.

I, too, am finding this forum later, in 2015. I'm nervous about what I've read about Aetna approvals because I'm not sure my breasts are large enough for them to see the medical necessity, even though I have all the pain that comes with breasts too large for your body. I'm 5'7, 130 lbs and a DD and my ideal would be a small C. However, everything I've read indicates that Aetna wants there to be a lot of tissue removal (more than the 500mg that I want) per breast for them to see it as valid.

Plus, do they normally approve BR surgery before you try other methods like physical therapy and medicine, or is trying those things standard before you get an approval? This seemed unclear to me when people got their approvals in a few weeks--had they taken those measures beforehand and had the paperwork all submitted together, or did they not even have to undergo those for Aetna approval?

I know I have a lot of questions but I really appreciate people who take the time to provide answers! Thanks :)
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