Your Aetna experience?

amy123 · April 23, 2008

Ok so today I went to my PCP and she referred me to my surgeon... and let me tell you she was VERY negative telling me over and over how long this process could take... I kept on pushing that I didnt care and was willing to wait... I have to go to the seminar before the surgeon will even meet with me. I was lucky and there was a seminar this Thursday with a cancellation so they let me in! I hope the rest of this process goes so smoothly but something tells me im bound to hit bumps but i have faith that I will be banded soon! Can anyone tell me exactly what you have to do during your 3 month multidisciplinary diet thing so I have some sort of idea?? Also Ive been on a diet with the dietician although I continue to gain... could this be grounds for denial or should I start the diet with the dietician fresh??

Flowerpurr · April 23, 2008

Dear Amy123,

For the 3month prep diet you ahve to see a Ditecian, Exercise Phys, PCP, and a behaivor Modification specalist.

Flowerpurr · April 23, 2008

Did anyone have to prove they tried losing weight before they decided to go for the lapband? I have lost weight before but not under any Dr.'s supervision except when I was on Phen Phen but I no longer remember who the Dr. was. So can anyone give me advice? Also did anyone write their own letter to Aetna to get approved.

polly522 · April 23, 2008

I wrote a letter of medical necessity (why I want the surgery), a weight loss attemps letter (with pictures) to the insurance company. This was required by my surgeons office upon my first visit. I am currently going through a 6 month diet plan ( going on month 5 ) woohoo, so I am almost finished with my requirements. Yes this has been a long process, but will be well worth it. I just hope I get approved the first time, and do not have to appeal.

Flowerpurr · April 23, 2008

Well good luck I hope you get approved as well. Why did they make you write a letter as well? I was just going to do it because I want to get approved the first time around. Also why did you chose the six month diet verses the three month diet?

polly522 · April 24, 2008

I wanted to do the 3 month, but I was told that it would be easier to be approved if I had the six month under my belt. The coordinator in the office said that she rarely saw the 3 month get approved the first time, because Aetna are such sticklers.

polly522 · April 24, 2008

They made me write a letter of why I needed the surgery, along with all my weight loss attempts. Basically it was a letter of medical necessity.

miss meliss · April 25, 2008

I just found out..... I got APPROVED!

I got the message after the doctors office had closed so I will call tomorrow and find out a date!!!

I so excited & happy!

polly522 · April 25, 2008

CONGRATS!!!!:rolleyes2: Good news for you! I cannot wait for that day!

lonestar5212 · April 25, 2008

Aetna only required that I do the three month supervised diet and exercise. My surgery center did that for me. I was not required to see exercise phys., my PCP was not required to be involved other than supply my medical records from my visits with him , and I did not have to see a behavior modification specialist. It depends on what YOUR particular ins. critieria asks for. Even though we all have Aetna, we all have different policies. Know the criteria in yours.

Flowerpurr · April 25, 2008

Hi Lonestar,

All I was told was to follow their clinical bulletin which it use to read different. The only thing my company has a rule is that I be morbidly obese which I am. Other than that I have to follow Aetna's rules which I have been.

dogluvr · April 26, 2008

I wanted to do the 3 month, but I was told that it would be easier to be approved if I had the six month under my belt. The coordinator in the office said that she rarely saw the 3 month get approved the first time, because Aetna are such sticklers.

I dont believe this to be a true statement. My friend, myself, and a coworker did the 3 month regime and were approved all the same.

miss meliss · April 26, 2008

I just got approved using the 3 month regime too. As I understood it... a regular doctor would need a 6 month plan and a Weight lose doctor who has a dietitian on staff would only require 3 months. But you needed a month consultations with the Dietitian. I took the short road and there was no problem!

NeNe967 · April 26, 2008

Congrats Miss Meliss....You are on you way. I have no regrets. I have lost 20 pounds since April 8th.

cherieinnv · April 28, 2008

My surgeon, who is very knowledgeable about insurance, says the Aetna requirement for a 6-month supervised diet can be satisfied if you have been on a 3-month medically supervised diet (3 consecutive months) with the past two years, and 3 months "followup" months. So after 3 months, I am submitting to Aetna this week, because my PCP put me on a diet over a year ago and I saw him for 4 consecutive months. I also had to see the psychologist and a dietician, and come up with the 5-year history, which took some legwork to come up with one of the years. I had a "missing" year and a retired doctor for that year and I had to track the doctor down to find my records. She is meeting me tomorrow to give me a notarized statement for that year. Let's hope that works!