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Questions about approval



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Beginning to get pretty frustrated. My insurance gives two options, 3 month program or 6 months program. Both have a different set of requirements. I completed the three month program, my insurance covered most of the procedures and I chose to pay out of pocket for nutritionist and Psychologist, about 400 total. What they're telling me is that it has to be 6 months and to disregard what my policy says. Any advice? Btw, surgery is scheduled May 1, and I start the liquid diet tomorrow.

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Here is a copy and paste of my policy stating the three month requirements:

  • Multi-disciplinary surgical preparatory regimen: Proximate to the time of surgery (within 6 months prior to surgery), member must participate in organized multi-disciplinary surgical preparatory regimen of at least 3 months (90 days) duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member’s ability to comply with post-operative medical care and dietary restrictions:
  • Behavior modification program supervised by qualified professional; and
  • Consultation with a dietitian or nutritionist; and
  • Documentation in the medical record of the member’s participation in the multi-disciplinary surgical preparatory regimen at each visit. (A physician’s summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician’s initial assessment of the member, and the physician’s assessment of the member’s progress at the completion of the multi-disciplinary surgical preparatory regimen.); and
  • Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
  • Program must have a substantial face-to-face component (must not be entirely delivered remotely); and
  • Reduced-calorie diet program supervised by dietitian or nutritionist

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Did you figure out about the 90 day program?
I just finished mine and waiting for the doctors office to submit to Aetna.


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2 hours ago, Alaska1980 said:

Did you figure out about the 90 day program?
I just finished mine and waiting for the doctors office to submit to Aetna.

Well yes and no, my insurance says yes there is a 90 day program and if you followed everything, it depends on the doctor's notes entirely. They said it should get approved as long as my doctor outlines that I've complied and they believe the surgery is medically necessary.

They said if the doctor just provides a summary, that is not sufficient evidence for medical necessity with the 90 day program. I'm currently having this argument with my doctor, she doesn't feel like typing out notes for each of our visits.

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8 hours ago, Alaska1980 said:

Did you figure out about the 90 day program?
I just finished mine and waiting for the doctors office to submit to Aetna.

yo finished the classes as well and the tests

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I live in the middle of nowhere (100 miles to nearest town, I have to go 360 miles to see the surgeon) so I did not have any classes. I did see my pcp and nutritionist once a month, personal trainer every 2 weeks. Plus a weight loss counselor every week by video chat.

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Did you figure out about the 90 day program?
I just finished mine and waiting for the doctors office to submit to Aetna.




Alaska1980 I did the 90 day program for Aetna. No issues getting approved


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CaliRey is it your doctor’s office telling you to disregard your policy? Or is it your insurance?

My office wouldn’t schedule the surgery until I was approved ....


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My pcp was the one to suggest I try for the vsg but I do not think he has ever been apart of the process before. I can not type up the doctors notes but I did make sure we talked about everything that was supposed to be on the notes at every visit. Also I did type up a letter of medical necessity for him and he loved it.

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
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      1. This update has no replies.
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