:biggrin:Aetna Called me today and I was finally approved, I didn't think this day was ever going to come. I did the 3 month diet and submitted everything at the end of June. My weight history from 2006 was missing so I had to appeal and it took 2 months to go through appeal process. But it was all worth it today when they called me. After work I am going to go pay my $1000 down so they can schedule my surgery..If anyone else has Aetna there really is hope out there:biggrin: don't give up and be persistent it will happen as long as you meet the guideline.

Congrats! Keep us posted on your upcoming surgery!

That is awesome! I am just starting the process with Aetna, any suggestions? I want to make sure everything is A ok and smooth!! Thanks

I have Aenta and was approved. After I got the first set of bills after - they "couldn't find the approval". Thank god I had the letter they sent, because they couldn't locate it. Just make sure you get it in writing and hang on to that approval letter- you will never know when it will come in handy.

I'm wondering if it's even worth putting in, our insurance changes from Aetna to United Health Care on 1/1/09..... I'm thinking they will just put me off till after they aren't our carrier any longer. Our company does have it's own dedicated perauthorization at Aetna so it may go smooth. I see my surgeon on 10/28 it will be a tight window.

TMBOWE - The Aetna website says there are two options for the prepreation 6 month monitored diet or a 3 month plan where you have to have psych eval, nutrition...etc did you have those options or did they tell you 3 month monitored diet?

I did the 6 month diet, it was a pain in butt. I was 1st denied by Aenta and then I appealed to the State Insurance department, since I had met the requirements of Aenta. That's when I was approved. Which ever you document everything.

doots43.. Aetna will approve you, you just need to make sure you have everything they are asking for.. I did the 3 month diet. For this I seen the dietician every 2 weeks and she went over behavior modification, diet, and excercise then i seen my physician at the beginning of the diet and again at the end. What held me up was I was pregnant in 2006 and didn't think about not seeing my regular Dr. that year so when I had my Dr send everything in it did not dawn on us that 2006 was not there.. that is why i was denied.. So just make sure you have everything the require and you will get approved.. Good Luck to you

thats awesome, thanks I am going to do the three month diet hopefully too. I also dont think I have pcp records, but I do have obgyn records when I had my babies, do you think they will work? Its just to prove that you were overweight for so many years right?

Yeah you have to have the 2 current years of weight.. I submitted 2003, 2004, 2005, 2007 and 2008.. They all proved I was overweight but I was denies because 2006 was missing.. So make sure you have 2006 2007 and 2008 cause if not they will probably deny you.. Also make sure that your dietician gets a copy of the 3 month diet guidlines and that you go over all of that with her and she notates it all down.. I seen on here that some people pay extra to see and excercise specialist but I did not do that and was approved I just told the dietician I was walking on my break at work and going to the gym a few days a week she would ask me evertyime I seen her and then she would notate it in my file.. You may want to try something similiar.

I have proof from my PCP since Aug or Sep of 2006 when I saw him recently I realized that I hadn't seen him for almost a year to date since 2007, but I do have 2 years with him of my BMI being over 40 and I have high blood pressure, sleep apena, high cholestrol, two stints..I think I have plenyt of issues associated with my weight. As I said earlier I'm thinking my timing is off due to my company changing from Aetna to UHC at the start of 2009. Well see the surgeon on 10/28 and will take it from there they are the ones used to dealing with the insurance companies..I hope

Edited October 10, 200817 yr by JayTee562
submitted to soon

I'm wondering if it's even worth putting in, our insurance changes from Aetna to United Health Care on 1/1/09..... I'm thinking they will just put me off till after they aren't our carrier any longer. Our company does have it's own dedicated perauthorization at Aetna so it may go smooth. I see my surgeon on 10/28 it will be a tight window.

TMBOWE - The Aetna website says there are two options for the prepreation 6 month monitored diet or a 3 month plan where you have to have psych eval, nutrition...etc did you have those options or did they tell you 3 month monitored diet?

I have the same issue in regards to the insurance changing. I currently have BCBSNJ which is changing to Aetna Jan 1st. I have done everything BCBS requested as well as what the Dr required. All my info/test results/documentation is with the Dr's insurance coordinator now. I am worried that my current insurance will try to stall me till it runs out. I have read where that is illegal for them to do that though. I have a 47.5 bmi and more co-morbidities than I want to even think about. If I am denied it will only be due to something someone forgot to include because I have done it ALL!!! Psyche, nutritionist, cardiac clearance after Angiogram, h pylori test, blood work, gall bladder ultra sound & chest xray. I even did an extra (7 in all) months of monitored diet just so they couldn't say I didn't have enough days in.

One more thing I worry about (as if there weren't enough) is that I never had a regimented exercise program. I did what I could but w/COPD walking is pretty difficult at this weight. I do use my hand weights and my resistance band. Much of the exercise is in a chair. But it's moving. I can't afford a gym membership. I read Aetna required a supervised exercise program. Is that true? What's more is I don't even know if my employer chose to include or exclude wls in the new policy. They had it worded as "Medically Necessary" in the current one. Hopefully they have carried that over.

If you have any suggestions or information, I would really appreciate it!

I myself am in the process of working on the 3 month diet program with atena ins. glad to hear some good stories it gives me hope!!! thanks

My insurance is switching to Aetna in January. Can someone give me an idea of what the three month diet plan is like?

I'm at the tail end of my 6 month monitored diet with Aetna. My PCP has been my doctor my entire life. Literally from birth to now. I think I should be fine :laugh:

The 3 month diet plan is monitered by your family doctor as well as a lic. Diatician. you meet with the diatician and talk about your personal eating habbits, I have been keeping track of everything I eat and drink she looks it over at our once a month meetings and helps me with possible alterations. I see my family doctor for weigh in only once a month, when I meet with him, it is ONLY about my diet nothing else. I have not done my phsyc. eval.as of this time which is a requirement of most insurance companies. My family doctor wrote me a letter stating that this surgery very much aid me. My doctor stated failed attempts of other diets, as well as basic health concerns. I am seeing a personal trainer not required but, I know exercise is very important in the entire weigh loss program. please feel free to e-mail me with any questions jab66@cox.net I will keep you up dated on my status, I will be sending in my paperwork in about 2-3 weeks best of luck.

My insurance is switching to Aetna in January. Can someone give me an idea of what the three month diet plan is like?

Link to AETNA => Obesity Surgery

Member must meet either criterion 1 (physician-supervised nutrition and exercise program) or criterion 2 (multidisciplinary surgical preparatory regimen):

1. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record at each visit. This physician-supervised nutrition and exercise program must meet all of the following criteria:
   1. 
      
   2. Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and
      
   3. Nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least three consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of six months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.); and
      
   4. Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records;
      

or

[*]Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months 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:

1. Consultation with a dietician or nutritionist; and
   
2. Reduced-calorie diet program supervised by dietician or nutritionist; and
   
3. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
   
4. Behavior modification program supervised by qualified professional; and
   
5. Documentation in the medical record of the member's participation in the multidisciplinary 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 multidisciplinary surgical preparatory regimen.)
   

Edited October 14, 200817 yr by JayTee562
Pointed out link