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

Aetna 2015 Weight Requirements



Recommended Posts

Finally after 16 days and many phone calls, I was approved for my june 4 surgery. :D :D :D

Share this post


Link to post
Share on other sites

Finally after 16 days and many phone calls, I was approved for my june 4 surgery. :D :D :D

Congratulations!\

Do you submit all of the data, or did your physician?

If you submitted the documentation, were there specific forms?

Share this post


Link to post
Share on other sites

@@handymannynyc1 . . . CONGRATULATIONS!!!

Share this post


Link to post
Share on other sites

Congrats to those of you who have been approved!!!! When the time comes for my case to be approved, the success you all have had gives me hope of being approved with little to no issues.

Again Congrats!!!

Rhonda :D

Share this post


Link to post
Share on other sites

Finally after 16 days and many phone calls, I was approved for my june 4 surgery. :D :D :D

Congratulations!\

Do you submit all of the data, or did your physician?

If you submitted the documentation, were there specific forms?

The doctor submitted everything

Share this post


Link to post
Share on other sites

Finally after 16 days and many phone calls, I was approved for my june 4 surgery. :D :D :D

Congratulations!\

Do you submit all of the data, or did your physician?

If you submitted the documentation, were there specific forms?

The doctor submitted everything

Thank YOu Bunny! I was feeling a bit invisable as no one responded.

I am overseas with American insurance. They have a very different system here. Not sure how I will go about this, but I will figure it out on my own I guess.

Thank You again!

Share this post


Link to post
Share on other sites

So, question. I did a three month program specifically for diet and exercise at a facility. I have the paperwork that shows what I weighed at the beginning and at the end of that time, and recent weigh-ins at the Dr.s have shown that I have not gained all of it back. Most, but not all. Is that sufficient for Aetna do you think? Or will I still have to do the three month program? I have all the other clearances scheduled, just getting anxious about that one. Thoughts???

Share this post


Link to post
Share on other sites

I'm with Aetna as well. From my understanding you have to provide a 2 year weight history as well as follow a doctor's supervised diet program for 3 months. I'm unsure if you're able to follow a program that's not your surgeon. During the 3 months, there can be no weight gain or you'll be denied. Not sure if this info is helpful.

Share this post


Link to post
Share on other sites

The two year weight history is no longer required.

Share this post


Link to post
Share on other sites

In my experience having my PCP document my need to lose weight over several consecutive years was a good thing. However, his letter to Aetna also needed to indicate the same. My BMI fluctuated between a 38 up to 41 at time of this process. I was approved with no problem. My WL surgeons office knew how to put all docs together to meet their approval and they made sure I followed their checklist . From what I see on this site, that's the biggest part. I even gained 3lbs during my weight management period but ended with a net loss of 1lb submitted to insurance. Try not to stress.

Edited by muzical1

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

    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
      1. This update has no replies.
  • 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

    ×