Aetna New Requirements: What documentation for 12 visits?

[greenchilegoddess 14]

Hi everyone,

I'm new to all this, and trying to figure my way through Aetna's new 2020 policy on pre-op program requirements, which now say you can do 6 months of a program previously or 12 sessions over any period of time of an " intensive multicomponent behavioral intervention designed to help participants achieve or maintain weight loss through a combination of dietary changes and increased physical activity" (http://www.aetna.com/cpb/medical/data/100_199/0157.html).

My surgeon's office is pretty disorganized right now because of covid, and they briefly brushed me off telling me that my Aetna insurance requires 6 months of supervision. I'm thinking there's a possibility they are not familiar with the new aetna requirements. If you did do the 12 sessions over any amount of time, what did you do? I've seen people talk about doing WW virtual meetings to meet this requirement. If you did that option, what sort of documentation did you provide to Aetna to prove you had been 12 times? Did they accept it?

Any guidance or insight into Aetna would be great! I'm a PhD student, so getting this done in 4 or 5 months would allow me to actually get it done before the semester starts and I can't rest as much as I need to.

[TLE 15]

I have Aetna, I started my process in September because Aetna had a 6 month Dietician requirement, that changed to 3 months with the new policy in January. So I got 4 visits in 2020, they submitted for approval in January (since I met the new requirement of 3) and was approved for surgery. My surgery is scheduled for March 3.

[flgirl23 5]

I started in November and had to do 12 weeks of weigh-ins. It depends on your doctor's office but mine were all virtual. The doctor started on a program with re-shape where I had a virtual coach visit every week but then towards the end, Aetna stopped covering it so the doctor's office would just call me and I would give them how much I weighed over the phone. Just make sure you do not gain any weight because Aetna will deny you if you gain weight.

[greenchilegoddess 14]

2 hours ago, flgirl23 said:

I started in November and had to do 12 weeks of weigh-ins. It depends on your doctor's office but mine were all virtual. The doctor started on a program with re-shape where I had a virtual coach visit every week but then towards the end, Aetna stopped covering it so the doctor's office would just call me and I would give them how much I weighed over the phone. Just make sure you do not gain any weight because Aetna will deny you if you gain weight.

Oh wow this is SO helpful. I spent so long on the phone today with insurance and it seems like no one knows what needs to be submitted to meet that requirement (or at least anyone I could talk to). My surgeon's office coordinator kept repeating to me today that it's a 6 month requirement but that goes against the policy bulletin. I'm wondering what I can do to get them to double check that's the case. I'd love to get my 12 visits out of the way and get approved as soon as possible so I can schedule surgery a bit earlier so I can rest.

[JaysWife 22]

I started my whole journey in August 2020. I did 12 virtual classes as fast as they could get them out to me. My case was submitted to insurance with all of the required info at the Beginning of Nov. for a tentative Dec. surgery. It came back a week later denied stating that I hadn't completed 6 months of a supervised weight management program and they didn't send 24 months of documented obesity. (I've been obese since I was a very young child) So my nut. added on 4 more months of classes which I finished the first week of Feb. my claim was again submitted with all required info for a March 22 surgery date. I called today to check the status and once again was denied with the same thing being the cause again. I am at a loss of what Aetna wants because my surgeons office says they sent it all. All I know is I am devastated right now.

[katywv 2]

Greenchilegoddess were you able to get this sorted out with your surgeon's office? I have Aetna too, but my surgeon is insisting that the policy requires that the 12 sessions have to take place once a month for a total of 12 months! I can't get any help from Aetna. They just tell me to get clarification on the policy from my doctor.

[greenchilegoddess 14]

On 3/7/2021 at 10:28 AM, katywv said:

Greenchilegoddess were you able to get this sorted out with your surgeon's office? I have Aetna too, but my surgeon is insisting that the policy requires that the 12 sessions have to take place once a month for a total of 12 months! I can't get any help from Aetna. They just tell me to get clarification on the policy from my doctor.

Hi! Sorry, I dropped off the face of the earth for a bit. The truth is I don't quite think I have it figured out, but my Dr.'s office is saying 6 months still, even though the Aetna website says 12 visits. I also can't get anyone to help me at Aetna or give me a straightforward answer. I'm hoping to start going to a GP soon for some visits just to have some extra in case in the end the requirement really is 12. Insurance is SO frustrating, isn't it?

[BoyMom86 28]

I have Aetna and am currently doing my required visits. What I did was 12 visits with a nutritionist (2 a week), so it equates to 6 weeks. I will be done the second week in May.

*edited: I wanted to add, I was told either 12 visits with pcp (which would take 12 months), or the 12 nutritional visits. I would contact the insurance company directly. They can give you the requirements in writing. I hope this helped.