Stop Snoring Now

Will Aetna Insurance Cover??? Surgery…?

I’ve been looking into the Lapband Procedure and my Insurance, Aetna, will cover if I have any of these three listed co-morbid diseases: Diabetes, Hypertension or Sleep Apnea. I don’t have any of those but I have a huge hereditary background of Diabetic family members including close family such as: Father, Grandparents, Aunts and Uncles. However I have Asthma. I know there is a way longer list of co-morbid diseases so will those three be all that they will most likely stick by or is there a chance that mine can be approved even though they only state the three I listed above???? Pls only those in the health insurance business or those who have had personal experience. Thanks!

Well, first you have to verify that you don’t have any exclusions for weight loss/bariatric surgeries on your policy. (One employer who has benefits through Aetna may choose to exclude weight loss surgeries from coverage, while another employer with benefits through Aetna might allow it on their policy as long as Aetna’s medical guidelines were met.)

After that’s done (if you haven’t already), that’s when the evaluation process starts. Keep in mind that the insurer has to stick very closely to what their corporate medical policy states for approving a particular procedure is…otherwise, if they make an exception for one person, they have to make that same exception for everyone.

I’ve not seen Aetna’s corporate medical policy/criteria regarding lap band surgery. However, I’m quite familiar with the policy of a few other large insurers, and have seen files for multiple patients who were approved for the surgeries and also multiple files for patients who were denied for the surgeries. It all comes down to whether or not you meet the specific criteria that Aetna has established a person must meet to be approved…its highly unlikely that any exceptions to their medical policy would be made.

Your best bet in trying to figure out whether you meet the criteria is for either you or your physician to get a copy of Aetna’s official medical policy/criteria for lapband surgery. Then you and your physician can review this information together to determine how to proceed…if you feel that you meet/exceed the criteria set forth by Aetna, then move ahead with requesting pre-approval for the procedure.

Only you and your physician can confirm whether you meet the criteria. If what you’re asking us here is whether or not an exception can be made if you *don’t* meet the criteria, unfortunately I’d have to tell you that its unlikely. (Again, the corporate medical policies are set for a reason…to establish specific cutoffs for approval so that the insurer knows where to draw the line between who gets approved/who doesn’t. The minute one person gets an exception, then the insurer opens themselves up to all kinds of liability from other people who’ve been denied. So, if you and your physician don’t think that you meet Aetna’s criteria or at least are a close borderline case that should be reviewed, I would not get my hopes up too much about getting approved.)

Good luck…and definitely review a copy of Aetna’s medical criteria with your physician to see where you stand!

HBP 020- How is snoring and sleep apnea linked to High Blood Pressure

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Biology, Psychology, and Behavior in Cardiovascular and Pulmonary Disease, an Issue of Nursing Clinics $54.89 Used – This issue of Nursing Clinics contains a plethora of information related to the biology, psychology, and behavior in cardiopulmonary disease. Some of the articles contain information on cardiovascular consequences of primary pulmonary hypertension; respiratory and cardiac manifestations of obstructive sleep apnea; knowledge, attitudes, and beliefs about heart disease; nutrition considerations for heart failure; and heart lung interactions during mechanical ventilation and weaning from ven

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Kaplan’s Clinical Hypertension $99 This best-selling clinical reference by a world-renowned authority on hypertension was listed as the #1 reference book for hypertension by the American Society for Hypertension in 2006. Dr. Kaplan integrates the latest basic science findings and clinical trial data and presents up-to-date, practical, evidence-based recommendations for treatment and prevention of all forms of hypertension. Abundant algorithms and flow charts are included to aid clinicians in decision-making.For this Tenth Edition, Dr. Kaplan has a co-author, Ronald Victor, MD, to handle the basic research aspects of hypertension. Highlights include new developments in the pathogenesis of hypertension; discussions on the significance of nighttime blood pressure; new information on the relationship of sleep apnea to blood pressure; updates on diagnosing primary aldosteronism; and detailed information on the latest antihypertensive drugs, including combination drugs.

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Medifocus Guidebook on: Obstructive Sleep Apnea Syndrome $19.5 The MediFocus Guidebook on Obstructive Sleep Apnea Syndrome is the most comprehensive, up-to-date source of information available. You will get answers to your questions, including risk factors of Obstructive Sleep Apnea Syndrome, standard and alternative treatment options, leading doctors, hospitals and medical centers that specialize in Obstructive Sleep Apnea Syndrome, results of the latest clinical trials, support groups and additional resources, and promising new treatments on the horizon. This one of a kind Guidebook offers answers to your critical health questions including the latest treatments, clinical trials, and expert research; high quality, professional level information you can trust and understand culled from the latest peer-reviewed journals; and a unique resource to find leading experts, institutions, and support organizations including contact information and hyperlinks. This Guidebook was updated on September 20, 2010.Obstructive sleep apnea syndrome may be defined as a cessation of breathing characterized by repetitive episodes of airway obstruction caused by collapse of the upper airway during sleep. Classic features of patients with obstructive sleep apnea syndrome include: * Excessive daytime sleepiness * Loud snoring during sleep * Fatigue * Obesity or being overweightResearch has suggested that there is a strong association between obstructive sleep apnea syndrome and cardiovascular diseases including: * Hypertension – high blood pressure * Congestive heart failure – accumulation of fluids in the lungs and other body tissues caused by insufficient pumping of blood by the heart muscles * Arrhythmias – irregular heart beats * Stroke * Angina pectoris – chest pain that occurs in people with underlying coronary artery diseasePolysomnography (overnight sleep test) is considered to be the most accurate test available for establishing

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Obesity and the Six Degrees of a Morbid Weight Disease, with Focus on Causes of Obesity and How to Overcome the Disease $15.95 New – This book contains information on the history of obesity among people. The main focus of this book is about the health concerns that are associated with the disease. Some of these diseases are, cancer, diabetes, hypertension, and obstructive sleep apnea. You will also learn about the causes of obesity along with ways to cure and overcome the disease.This book was created and put into distribution by a team of dedicated editors using open source and proprietary publishing tools. One of the

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