Has anyone been approved or denied by Aetna POS in the 90 day plan and what did you do for the exercise requirement?

I am pre-surgical and interested in doing the 90 day vs 180 with Aetna. My dr office (Magee) seems to favor the 180 and neither they nor Aetna can give me a good explanation of the exercise requirement "Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional;" which seems to be the only difference b/w the 90 and 180 day prep plans.

Thanks!

I didn't do anything for that part. Just met with the nutritionists every month.

That's great to know and congrats on your amazing weight loss!

39 minutes ago, Louie'sMom said:

That's great to know and congrats on your amazing weight loss!

Thanks!!

I have the same insurance and just finished the 90 days. That exercise part was very confusing at first. When I called Aetna they were very vague. My bariatric coordinator was even confused about how the Aetna policy was worded.

"Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional;"

I called around and finally spoke to a physical therapy place and they said they were not familiar with what an "exercise therapist" was. However, they said they would be glad to work with me. It just so happens that their office is inside of our local YMCA. So, I called Aetna to make sure they the physical therapist that was working with me on my exercise regime was acceptable, and they said that was fine.

I've even heard of people that were successful with this requirement by hiring professional trainers.

My paperwork was submitted this week. We shall see........

HI - congrats on your Weight Loss so far and thanks for replying. After much chasing and asking to speak with a bariatric specialist I got some answers from Aetna today. I had read the policy thoroughly and was still very confused. The Aetna rep assured me that what I am doing is good and the nutritionist and surgeon signing off on my self reported exercise will be sufficient for approval.

Good luck on your approval!

Hi Louies'Mom - I hope this helps as I just completed my 90 day play with Aetna and have been told today that my case was submitted to them.

For the exercise portion this is what happened. When I had my initial visit with my Surgeon and his team they had a dietitian onsite and have a really good understanding of what all needs to be done, they refer people to a Physical Therapist office (In this case Sovereign Rehabilitation). I had them schedule my appointments the same day as my dietitian appointments so there would be no confusion of when I went.

My first appt with the therapist was pretty simple, she just talked to me about my exercise history and showed me some exercises I could do at home that we're not to hard to do. She then gave me some paper work that was info about her wanting me to workout 5-7 days a week for at least 30min a day and to get my heart rate up to a certain level depending on what I was doing (cardio or weights).

The appointments following she would have me on the treadmill for 30min increasing the grade every 3 min up to a grade of 5 and then back down to until 1, again every 3 min. Then she would have me do some lunges and squats with a resistance band around my ankles, she would throw in some other similar types of things. Usually after 45min or so we were done and I was out of there.

Good Luck!

Very Helpful. Thanks so much! Does seem more intense than what Aetna told me they needed. Hope you're doing well.

Very Helpful. Thanks so much! Does seem more intense than what Aetna told me they needed. Hope you're doing well.

It may have been a little more than needed, but it certainly worked! I got my approval on 5/1 and am waiting for the surgery scheduler to call me with the date!

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Congrats!

I got my approval within 2 days and am set for lap band on June 6th. do you have a date yet?

We will be surgery sisters! I'm getting sleeved on June 6 !

That is AWESOME! So excited for you! Please let me know how it goes and Good Luck to you