question about Aetna Insurance-3 month (90 day) multidisciplinary diet

Lexie T · July 16, 2011

I know it's late but I'm up obsessing over surgery and reading between the OH website and verticalsleevetalk...hopefully when people wake up, someone will help me!

So this is what I'm pondering... I am starting my diet for insurance approval. My surgeon's staff offers a free six month plan with the dietician that the average insurace requires. However, for those who did the 90 day fast track with Aetna, I'm having difficutly finding clarity on the what that exactly entails? What were your steps? Should I see the nutritionist offered by the surgeon and also see my PCP monthly to meet the requirement? And what did you do for the excercise element? Can someone break it down for me PLEASE! I have searched and read brief posts about it, but I need something in layman's terms. Aetna's member services and the pre-certification deparment had the freaking nerve to tell me that they had no way of clarifying to me what "THEIR" policy meant! I couldn't get rid of my blank stare as I listened to them in frustration and disbelief. They said ask the surgeon... as if he wrote it! LOL Please help me...pretty please!

Kami · July 16, 2011

Hey Lexie,

Don't freak out too much. Its a little confusing, but you'll get through it.

I did the three month plan through my surgeon's office. I went once a month and saw the surgeon and the nutritionist. I had to document what changes I was making to try to lose weight. I lost weight the first month, gained 2 pounds back the second and stayed the same but lost fat/gained muscle the third.

I was also required to meet with an exercise physiologist, which can be done at my clinic's exercise group sessions, but they were all scheduled in the evenings, when I work. So, I talked to the exercise physiologist on the phone, she emailed me a plan, and I started walking. I never got a clear explanation on what all can count for the exercise component. I don't know if a personal trainer at a gym works. Since I couldn't get the clarification, I just went with what my surgeon had. Other people (on OH) said a trainer would work, if they wrote up a detailed summary and submitted it to the surgeon.

So, after three months of doing this, I was done. My surgeon's office is stupid to the max (I made a separate post on this), so they didn't actually submit my packet for almost a month, then it was approved within 2 days. I'm still awaiting my date (again, stupid office).

There is probably someone in your surgeon's office who does the paperwork for submitting to the insurance. That is the person to talk to about meeting the requirements. Hopefully s/he will know about the 3 month option and be able to advise you.

If you can see the nutritionist at the surgeon's office for free, do that once/month and then do once/month appointments with either the surgeon or PCP - either will work, so go with whatever is cheaper, or whatever you feel more comfortable with.

If you have any more questions, let me know and I'll try to help.

Kami · July 16, 2011

oh, and I have Aetna too, by the way

kbowlin74 · July 16, 2011

I used the nutrutionist at my surgeons office, went to my PCP and had my records where I checked in at the gym at least 3 times a week. Now keep in mind my check in at the gym was never submitted and I was approved by Aetna and have already had surgery.

longer-life · July 17, 2011

I also have Aetna. My suggestion is that you find an experienced surgeon AND staff. That is what I plan on doing.

From what I have read on this website, many surgeons have a staff member that is used to dealing with many insurance companies and are very knowledgeable. Best wishes!