I have Aetna Aexcel Plus Choice POS 2.

I have been researching on Aetnas website about weight loss surgery and I still have a couple questions that some of you might be able to answer for me.

First off, is there anyone here that has Aetna insurance and DID NOT have to do a medically supervised program for 3-6 months?

I was reading on Aetnas website that you have a choice to do either the three month program or the six month program. Can someone please enlighten me that chose to do the three month program and what all they had to do?

Thank you so much!

I have Aetna Select. I did a 3 month program. I had to see a dietician for those three months, behavior modification, ( i worked out with my surgeon's pt and keep meal logs) and have a nutritional evaluation. I had to do a psych eval as well.

How many times did you have to see your dietician?

I also am doing the 3 month. I have to see the dietician 4 times total. The last visit is for a weight check only. Basically you have to meet with the dietician, log your meals, met with a physical therapist 3 times and a phyc eval once. They are also having me go to my pcp 3 times also to cover all the basis. Your surgeon's office will help you through all of this. They deal with insurance companies all the time. Good luck with your journey. I have my last visit on sept 30. Everything will be submitted to the ins co after that for approval. I have been told aetna approves pretty quickly after that. You may also be required to show weight history for the past 2 yrs.

Yes in my other thread I address my weight history question. I have a BMI of 43-45 for 2010 and 2009. I do NOT have anything for 2008. Do you think they consider the LAST two years to be 2010 and 2009? I know this is a stupid question, but I just want to make sure I have everything covered.

I meant to say in my last post that I have medical records for 2010 and 2009 showing my BMI over 40.

They look at 2008 also. Did you go to your obgyn during that year or weighed at a gym? A guy at my work did not have anything from 2008, but they accepted a copy of his drivers license as proof. I was pregnant in 2008 so I have several weight checks. Hope this helps

in 2008 I went on a hardcore diet and lost 80lbs. Unfortunately gained it all back PLUS some within about 6 months. Are you 100% positive they look at 2008?

I have a medical record from February 2009 with a BMI of 43 and a record for August 2010 with a BMI of 45. That is nearly two years. I just don't see why they wouldn't take that. I guess because insurance can be a b****

By the time I even get my surgery it will probably be January or February 2011 by the time I jump through all my hoops.

That's true, it probably will be 2011 so they would look at 09 and 10 then. From what I have been told, you don't have to have a bmi over 40 for the entire 2 years. They just want a history that you have been struggling with your weight. The weight lose and then the gain should help you to get approved. I was worried about losing weight during the 3 month because it would drop me below 40 bmi. So my goal is to maintain during the 3 month thing.

I saw the dietician 3 times (once in each March, April, and May). Then I had one visit with her for my nutritional evaluation. I submitted weight history from late 2007 nothing for 08 and the rest came from 09 and 10.

Yeah when I was 15 years old (2005) I weighed 270lbs. During that year I lost 80-90lbs so when I was 16 (2006) I weighed around 185lbs. Then it slowly crept up on me and now I'm 20 years old and back at 270lbs. I've honestly had a lifetime of obseity. I've ALWAYS been the "big girl" for as long as I can remember. I guess when I submit my papers to the insurance company, it will help to have a BMI of 40+ for two consecutive years and a lifetime of obesity.

I mean, I think if I jump through all my hoops and do all the vists I THINK I should be approved when I submit my papers January 2011. I don't see why not. Especially with adequate weight history records.

i have aetna and i'm doing the 3 month program. my doctor requires a lot more than the insurance company is requiring, but i'm ok with that.

- i have to see my PCP once a month for three months in a row for a weigh in (she also

needs to send aetna a letter with all that good stuff), she also has to oversee my other

appointments

-my surgeon requires i write a personal statement letter saying why i feel i need the

surgery

-i need a psych evaluation and nutritional consult

-doctor requires i go to at least one exercise program class

-i need to get another sleep study test done (although i had one in 2008; gonna ask

again if i can get out of that)

-i also need to have an endoscopy, see the cardiologist and some other GI doctor

and i need to this all within 3 months and try and lose some weight. my surgeon suggested i replace one meal a day, 3-4 times a week with a meal supplement drink, then work my way up to once a day so that i can get use to drinking shakes, and lose weight.

it's a lot, but worth it imo

This is what I was told after I had completed 3 months with my pcp. During the 3 months you have to meet with 3 people. 1: your pcp for the charting of the weight 2: you have to meet with a dietician all 3 months to log the diet/meal modification she suggest and 3: an exercise professional that can log the exercise program he/she put you on for the 3 months..

The first surgeon I met with seemed to really know what he was doing and he was highly praised for his practice, but the office failed to inform me that I had to meet with all 3 people every month during charting.. I did my pysch eval I did the "4" months charting and I did the dietician consult just to be told I had done it wrong. However because I already had 4 months of charting under my belt I am going to finish out the 6 consecutive months with my pcp.. He will be the only one charting my weight, diet and exercise program. I am also fixing to have a sleep study done for Aetna.. They have not told me it is required, but a friend of ours with the same company had to have one at Aetna's request, because her being over weight wasn't really grounds for surgery. Aetna has a lot of loops you have to jump through to get what you want at the end, but it is well worth it..

I have Aetna and my experience went fairly well. I had 1st consultation with surgeon in March, was approved in June with every piece of documentation needed; had surgery July 1.

When the plan says monthly, they mean once a month, not 30 days. You can have an appt Oct 5, Nov 27 and Dec 3. but you can't have Oct 30, Nov 30 and Jan 1. That 2 day difference will cause you to get denied!!

I needed 5 year documented weight charts (go with your highest weight and request med records). They want to see the yo-yo. If you have WW weight card, use it!

Even though you can 3 months with physician (& nutritionist) or 6 months alone, it's best to do the 3 mos because the surgeon's office will make sure you've got what you need, if one thing is missing, you're not getting approved. Not even with an appeal.

If your surgeon has a nutritionist, go with them instead of your own. They work as a team.

The plan requires certain things. If your surgeon requires more, if you don't think it's necessary, such as a sleep study, discuss it. My surgeon requested Iron fusion treatment (not covered and I wasn't paying out of pocket).

The success of surgery is dependent on the tests and findings. This is why your surgeon requires additional tests and studies.

Furthermore, the plan requires a certain BMI. Higher usually aproved, but lower requires that you suffer from co-morbid conditions, even snoring counts. If you don't have any pain or issues, you can be denied.

I don't work for the insurance company, but I am the benefits administrator for my employer. I KNOW some things, but I don't know everything or every plan. Drop me a line if you need some insight. ~~Sonja