Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Aetna 3 Months Question



Recommended Posts

Hello everyone,

I have Aetna and now I'm doing the 3 months multidisciplinary program. I know that I have to see my doc and nutritionist once a month at least . I travel alot bcz of my work so my question is , Do I have to see them one time during the 30 days or its ok if the gap between the visits exceeds 30 days ? for example I visit my doc early January, Late Febuary and mid March ? will that work for Aetna ?

Thank you

Share this post


Link to post
Share on other sites

You need 4 visits in 90 days. Days in between don't matter. I think mine was like 20 days, then 35 days, etc, and I got approved no problemo.

Share this post


Link to post
Share on other sites

You need 4 visits in 90 days. Days in between don't matter. I think mine was like 20 days, then 35 days, etc, and I got approved no problemo.

Hey DougNichols,

Thanks for your answer ! What was your 3 months like ? did you have to log your food and exercise everyday? Did the doctor office send your logs to Aetna ? How long did it take Aetna to approve your surgery ?

Thanks

Share this post


Link to post
Share on other sites

I have Aetna and they were very strict about my doctor visits. I had to see my PCP every 30 days. It could not be one day over 30 days or I had to start over! Honestly, my surgeon had to create a doctor's visit because I went more than 30 days once.

During the 90 days, your doctor is suppose to put you on a diet. How strict the doctor is, depends on the doctor. My surgeon provided me with a form for my PCP to fill out each time I visited. It asks for my weight, blood pressure, a description of diet plan, exercise I was doing, and any other notes the doctor wanted to make. This was helpful, because I was able to personally take this documentation back to my surgeon to submit to the insurance company.

My PCP was not strict about my diet. I gained weight the first 30 days and maybe only lost 5 pounds in the next 2 months. This had no bearing on my approval.

I hope this helps. Good Luck!

Share this post


Link to post
Share on other sites

Hey DougNichols,

Thanks for your answer ! What was your 3 months like ? did you have to log your food and exercise everyday? Did the doctor office send your logs to Aetna ? How long did it take Aetna to approve your surgery ?

Thanks

I only saw the nutritionist. Since I had been reading this board for so long, I knew everything she was saying, so she kinda gave up and just handed me the "official documentation" for post-op diet, nutritional guidelines for my 3 months, etc. Our visits lasted like 15 minutes each.

I did not log my food.< /p>

The surgeon's office had to obtain all sorts of extra documentation from different people, which took a week. Then I was approved after another week. Since it was Christmas time, it took a total of 3 weeks from the last nutr appt to approval.

Share this post


Link to post
Share on other sites

For Aetna on my plan with the 3 month plan it also required monthly visit with an exercise therapist. Since we couldn't afford another out of pocket expense for that, my husband is just doing the 6 month plan. I kept my visits pretty close to the 30 day mark but did not go past 30 days. Once they had all my paperwork I was approved in 24 hours.

Share this post


Link to post
Share on other sites

When I went the first seminar in September 2010, the doctor informed us that Aetna had a 3 month option. I was determined that I would get all my ducks in a row so that I could have the sleeve done as soon as possibe. I met all the requirements by Dec 9th (3 monthly nutrionist visits, exercise physiologist, pysch eval, web tutorial, and support group meetings). When I asked the staff if they could submit my paperwork for Aetna approval, they initial refused. They indicated that the majority of patients before me who had submitted were denied and had to complete 6 months. I was devasted! When I got home, I immediately called Aetna to inquire as to why, having met all the requirements as defined in their policy, I would possibly be denied. They told me I should go ahead and submit for approval and it should be accepted. When I called the doctor's office back, they seemed really reluctant to submit but I insisted. GUESS WHAT? On December 28, Aetna approved my surgery without question. Hoorah! Needless to say, they were very surprised at the doctor's office. I've been on the fast track ever since to be prepared surgery on Jan 26th. Today, I started my pre-op diet.

The morale of my long drawn out response...don't rely on the doctor's office to fill in ALL the blanks. Make sure you call Aetna to clarify what is required.

Share this post


Link to post
Share on other sites

i had this question as well. i initially started doing the 3 month option, but my surgeon got rid of her private practice and moved about an hour away and my appts, got switched around so i'm now on the 6 month option. i started in sept. 2010 and saw my PCP 4 times since then. my surgeon stated i only needed 3 meetings with my PCP. but i will reconfirm that when i see my surgeon next month and will call the insurance company. i'm just need to make sure what i'm doing is right. i don't have a ton of support from my surgeon with follow up

Share this post


Link to post
Share on other sites

I just finished my 3 month requirement. Like a few of the other comments, each visit had to fall within 30 days of the last visit, not a day over. My surgeon is submitting my paperwork tomorrow. I never saw my PCP. All my weight management classes were done through my surgeon's office.

Share this post


Link to post
Share on other sites

Yep I have Aetna, and did the 3 month requirement. My visits weren't exactly 30 days apart but I did have to make sure that my 4th and last visit was exactly 90 days from my first one. I hear Aetna is a stickler on that. But once all my paperwork was submitted I was approved in no time - well I take that back, I was approved within 24 hours once they found my paperwork that they lost lol....

Good luck!!!!!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • vsg.with.sharon

      Hey everyone!
      I’m new here! Looking for some friends! 🥰
      · 0 replies
      1. This update has no replies.
    • LeighaTR

      Four days post surgery. I am sipping as fast as I can and getting NO WHERE near the goal of 60 - 80 grams of protein or the 64 oz of liquids. I just feel FULL. I don't know if it can still be the gas build up (I would think by now that would be gone) but it is a struggle to drink. And so far I have not had the nausea or spasms and don't want to wander into that territory by pushing too hard with liquids. I about passed out today as it was my most "strenuous" day. Went from second story to basement for shower and I was sure I was going to pass out. Looking back on my last few days I have had a total of less than 1000 calories. Am I just not getting enough nourishment in me? Once again a friday where I can't get ahold of the doc until Monday rolls back around so I am hoping maybe someone here has some experience on how to keep energy going. I do have fibromyalgia too and that may be where some added fatigue comes into play. How did you all fair with the goals the week after surgery?
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 3 replies
      1. Phil Penn

        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×