Is It Me Being Crazy Or Them Being Clueless?

[Raven21 121]

I'm just so nervous about checking all the right insurance boxes. My first appt was with the bariatric center coordinator type person. She set me up for the following week with nutrition and psych. I finish with that and they ask if I've had the exercise eval yet. Nooooo. So they set that up. I asked if there was anything else and they asked if I had my other 2 psych appts scheduled yet. Noooo! I'm just afraid I'm not asking about something I'm going to end up needing!

The nutrition person (who my friend who had WLS 5 years ago says was crucial to her success) was very brief. Said it was no big deal and she'd have me out of the appt in 20 minutes and do the next apt over the phone in 10 minutes. I thought the nutrition stuff is important?

So after my 2nd psych appt I asked the front desk person about the process for submission, etc. She tells me about the meeting with the doc and pre-op testing, which can be done in a day. Except for the thing where they put you to sleep and stick the tube down your throat (her exact words) which takes 2-3 weeks to schedule but maybe I could schedule it in advance but she's not sure.

I have my heart set on getting this done in 2012. Not to mention my insurance co-pays start over on 1/1/13. Everyone seems to have just a bit of the info., but not the whole story.

So I called Aetna. 4 different people couldn't even tell me if 90 days meant 90 calendar days or 3 months. They referred me back to my doc!

Arghhhhhhhhhh! Maybe this should have been posted in the "rants" section!

[Ms skinniness 3,003]

All this stuff is extremely anxiety provoking. If I was you, I would call the surgeon's office and ask them for a list of things that they require to be completed to present to the insurance company for approval. That way you can be proactive in getting those things done ASAP. Best wishes and I hope the process goes faster.

[funkeechiggen 135]

I have Aetna and the insurance coordinator at my surgeon's office said Aetna is VERY particular about when your nutritionist appointments are scheduled. When I had my first consultation with the surgeon back in June the coordinator sat down with me and scheduled the 3 nutritionist visits (one each in July, August and September). They scheduled the first NUT visit 30 days after my initial consultation because they said Aetna has denied people for not doing that! Also, each of the 3 nutritionist visits have to be at least 30 days apart and if you miss one you have to start the process over!

I have my last NUT appointment next week and then after doing the cardiac clearance tests (immediately following the visit) they will submit to insurance!

Good luck with your journey!!!

[funkeechiggen 135]

Also, as it was explained to me and it's outlined in Aetna's clinical policy bulletin (CPB), psych visits are NOT required unless you have a history of mental illness. Here's the c&p from the CPB:

Requirement for Psychological Evaluation:

Candidates for obesity surgery who have a history of severe psychiatric disturbance (schizophrenia, borderline personality disorder, suicidal ideation, severe depression) or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medications should undergo a comprehensive evaluation by a licensed psychologist or psychiatrist to assess the patient’s suitability for surgery, the absence of significant psychopathology that can limit an individual’s understanding of the procedure or ability to comply with life-long follow-up (e.g., defined noncompliance with previous medical care, active substance abuse, schizophrenia, borderline personality disorder, uncontrolled depression).

[Raven21 121]

They said the psych visits were to prove the behavior modification counseling.

[jusstice 103]

I also "had" t do the 3 psych visits. I claimed they were not required (I have three degrees and I have excellent reading comprehension), but they said it was. Whatever- I got to go bore the psych for three visits.

My initial meeting with the insurance coordinator, she scheduled the first meeting with the NUT,and explained that I needed to do three visits with 90 days with the NUT and medical. Only after a month went by did anyone mention the 3 PSYCH visits as well and the endoscopy. So, the PSYCH thing pushed me back another month. I have a fourth visit with the medical tomorrow, since I got pushed into September. I believe that my requirements are all done and they should be able to set a date for submission to Aetna (they can't submit without a date, right?). I am hoping/planning for something before October 22.

[Raven21 121]

Arghh! That's exactly what I'm talking about!

[GeauxForIt 659]

I read the Aetna Clinical Policy Bulletin when I started my hoop jumping with them so I'd be sure of the requirements bc no one seemed to know it all!

Google "Aetna CPB 0157" and that's the exact policy with regards to bariatric surgery. I printed a copy and carry the damn (highlighted) thing with me whenever I have an appt!! LOL

[WlsJenny2012 5]

My surgeon's office just submitted to Aetna today. I was assigned an insurance coordinator and she listed all of the items that I still need to complete before we could submit to Aetna. I then spent the next month or two getting all of the testing done. It seems to me (based on feedback that she has given me) that she is pretty knowledgable about Aetna's requirements. Boy, I sure hope so. I had to provide documentation for the following:

1) Medical records from my PCP for the past 2 years

2) Records of any medically supervised diet attempts for 6 months (consecutive) with PCP or 3 months with a Dietician. (On a side note, the nutritionist visits needed to occur in 3 consecutive months (meaning 1 in July, 1 in August and 1 in September)

3) Psychological evaluation from a licensed psychologist or psychiatrist

4) Clearances: Medical

5) Other: Letter of support from Physician which includes: health conditions, current medications, past supervised dieting attempts, and clear recommendation for weight loss surgery

6) Stress test

I hope this help!!!

[Raven21 121]

Thank you so much! Supposedly the Bariatric center I'm going to submits all that other stuff for me? I'm doing the nutrition, psych, and exercise stuff with their staff. This is the part that drives me nuts because when I submit, I want everything done by then, no more hoops to find out after submission. Submit - approve - surgery!