Aetna Net weight gain

[Lenamarie301 43]

I noticed on Aetna's policy topic about bariatric surgery that it says "no net weight gain". What exactly does that mean? I am going to a nutritionist and I have been twice. I gained 3 pounds. Not sure if it was Water weight or what but it was 3 lbs higher than my first visit. I am concerned because the scale at the surgeon's office had a completely different reading also. Can anyone provide some clarity on this subject?

[dede0314 356]

At the end of your program you need to be less or the same weight as you started.

[Lenamarie301 43]

Thank you! but do I need to be less than the date I first started the diet or when I first went to the surgeon and atsrted this whole process?

[dede0314 356]

Your first documented weight when you started the program with your surgeon. So my first weight was from my first appointment with the nutritionists.

[rking 484]

I have Aetna. They went by weight according to first nutritionist visit. If I gained any weight at all they would not approve surgery. Read fine details in the policy online. Talk to doctor and nutritionist and find out exactly what policy says. That is what matters, period.

[rking 484]

I am not clear. Did you gain from visit one to visit two? Or after visit two and before visit three? I HIGHLY recommend you do not see nutritionist until you have lost the three pounds. I would lose 3.5 to be safe. Also, some nutritionists let you do appointments by phone. That is very safe if you know what I mean.

[Womanvsmirror 314]

During my process I emailed Aetna and asked for clarification on this the response I got back:

Thank you for using the secure member website to contact Aetna. To help
protect your confidential information, please continue to use the secure
member website to contact us. This online form provides greater
security than standard Internet e-mail.

The CPB's can be highly technical. Members and consumers should review
the information in the CPBs with their doctors so that they may more
fully understand them.

The net gain means that you can not gain any weight during the 90 days.

You will need to ensure that this surgery is precertified, prior to it
being performed.

If you have additional questions, send us a 'Contact Us' message or call
the toll-free number on your member ID card, if applicable.

Sincerely,
Internet Response Team
Aetna
32680272

[Womanvsmirror 314]

I agree during my process I went up 1or 2 on one of my non weigh in visits I made sure I was down at least 4 by the next visit. 48 hour liquid diets and laxatives (which im not recommending) kept me right on the dot the whole time

I am not clear. Did you gain from visit one to visit two? Or after visit two and before visit three? I HIGHLY recommend you do not see nutritionist until you have lost the three pounds. I would lose 3.5 to be safe. Also, some nutritionists let you do appointments by phone. That is very safe if you know what I mean.

[rking 484]

Yes. The 90 days starts and ends with nutritionist. It actually ends up being 4 visits.

[Lenamarie301 43]

I went to the nutritionist for first time in june. Then 31 days later I went back and the scale said I was 3 lbs higher. I will have to check and see if the office allows are the phone visits. It says documented exercise... Who is supposed to document that???? I also asked several times how many nutritionist visits I needed and could never get a straight answer... This is what I found online:

1. Nutrition and exercise program(s) must be for a cumulative total of 6 months (180 days) or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least 3 consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of 6 months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.)

[rking 484]

Hate to tell ya but I think your 3 lb gain may have got you. Call insurance and check before you spend more money. Your nutritionist should know. Your policy may be different than mine.

Nut 'monitored' exercise as well, and diet.

[Womanvsmirror 314]

Again I had the same question about the exercise program. What my surgeons office did is when I went to my weight management (behavior modification ) class we had to fill out a sheet each time, Containing what are daily activity is like what we are doing for exercise and how long...we also made a food goal like cutting sweet tea , or reducing carbs.. I wouldn't count you out yet over those 3 lbs what is your current bmi? I ask cause even though I had to not gain weight I did not have much wiggle room to loose either . But if you are able to stay above the required bmi with no issue push as hard as you can to drop 5 before the next visit. and do not gain another lb if possible. I was so obsessed about this part cause i knew this was the one part of the approval process that was totally up to me. Aetna is strict about the weight gain but make sure its documented somewhere that either you are on a certain med that makes you gain , Water weight , cycle time etc.

[Lenamarie301 43]

My BMI now is 38.8. I hate that the surgeons office won't submit for an authorization from AEtna until after I have done everything because aetna will tell me nothing so I will like I am running in circles.

[dede0314 356]

If they submit before you complete your program they will deny you for not completing the program. Don't get discourage. Make sure you don't gain anymore weight and complete the program and all of Aetna's requirements. Don't let anyone discourage you if I did I wouldn't be where I'm at now. Good luck!! Keep us posted.

[KristenLe 5,980]

My BMI now is 38.8. I hate that the surgeons office won't submit for an authorization from AEtna until after I have done everything because aetna will tell me nothing so I will like I am running in circles.

Call the insurance coordinator at your surgeon's office and ask if she can help you figure out detailed requirements. Some plans make you start over (with supervised diet) if you've gained at all. It all depends on your specific plan.