Question about 3 & 6 month diet on Aetna...

[adagray 1]

If you go to your PCP for your physician monitored weightloss, then does Aetna pay for those visits normally? Or, is it one of those deals that the visit has to be coded as for weightloss and they won't pay those codes so its not covered? I'm trying to decide if I should go to my PCP for the diet or go to my surgeon's office. They offer a 6 month program for $750 that covers what is needed for the physician supervised weight loss. They also say that it facilitates approval to go through them (probably cause they know exactly how to document it). BUT, if I only had to pay my co-pay ($20 each time) to my PCP, I'd rather go the cheap route and go to her for the weightloss visits unless there is any other benefit to going to the surgeon's office. I suppose if I went to the surgeon's office they may be able to actually give me diet advice that is geared towards getting me ready for the post surgery diet.

Anyway, just looking for any of your experiences and thoughts on this. My other question is under what circumstances can you do a 3-month diet instead? I don't hear a lot of people mentioning that on here, but it is in my documentation from Aetna. Honestly, I don't care if it takes 3 or 6 months, but if I am to spend any time on another 'diet', I prefer that it be geared towards teaching me something that I don't already know... like tips/strategies/habits that I need to develop to support my success after the surgery so its not a total waste of time.

[tashanicole1271 0]

I have Aetna also and I went to my PCP for the supervised diet. It was for 6 months. My doctor made a weight loss template that she wrote her recommendations for me on every month. When my 6 months were up, I submitted those sheets along with all of the other paperwork and documentation that Aetna required. I am scheduled for surgery on the 14th. The time passes rather quickly. I would suggest that you do it for 6 months as opposed to the 3, just to make sure you have all the bases covered. Good luck to you!

[KyBandChick 3]

I have Aetna and did the 3 month multi diet. The hospital where my surgery is performed offered the program as part of my surgery fee. The 3 month process was really easy. Once a month I met with the nutritionist who 1 month just had me try and change a few habits then the next month had me write down everything I ate then nothing new the third month. After each visit with the nutrionist I went and met with the hospital exercise physiologist where they weighed me and reviewed my exercise journal which was all submitted to my insurance. I also did the psych evaluation (which was a joke).

[Ronda1966 0]

If you go to your PCP for your physician monitored weightloss, then does Aetna pay for those visits normally? Or, is it one of those deals that the visit has to be coded as for weightloss and they won't pay those codes so its not covered? I'm trying to decide if I should go to my PCP for the diet or go to my surgeon's office. They offer a 6 month program for $750 that covers what is needed for the physician supervised weight loss. They also say that it facilitates approval to go through them (probably cause they know exactly how to document it). BUT, if I only had to pay my co-pay ($20 each time) to my PCP, I'd rather go the cheap route and go to her for the weightloss visits unless there is any other benefit to going to the surgeon's office. I suppose if I went to the surgeon's office they may be able to actually give me diet advice that is geared towards getting me ready for the post surgery diet.

Anyway, just looking for any of your experiences and thoughts on this. My other question is under what circumstances can you do a 3-month diet instead? I don't hear a lot of people mentioning that on here, but it is in my documentation from Aetna. Honestly, I don't care if it takes 3 or 6 months, but if I am to spend any time on another 'diet', I prefer that it be geared towards teaching me something that I don't already know... like tips/strategies/habits that I need to develop to support my success after the surgery so its not a total waste of time.

I have Aetna PPOS, and I did the 3 month program . I did not have to do a diet ,but I did get weighted once a month for three months (doctors ) office. I had been in Weight watchers for 5years(off and on ) ,and Curves for Woman .That showed I tried to lose ,and did at times only to regain . .I go in for my band on January 14TH ,the process went fast for me started Sept.28TH 2009 was approved Dec.24Th.

If you feel you need to do the 6 month program you do what you feel is right for you ,and that way you will be successful .I know that Aetna does help with weight lost Programs and I believe Weight Watchers is one of them ,also Jenny Craig .I think you get a discount on the programs and they can use that as weights towards (insurance approval) ,it did for me .I didn't need to do the 6 months and saved moniy that way ,it cost $39.00 a month and you have E -tools online to help with recipes and excise. Which ever way you go ,I wish you luck and hope you do well ,Best Wishes.

[Ronda1966 0]

If you go to your PCP for your physician monitored weight loss, then does Aetna pay for those visits normally? Or, is it one of those deals that the visit has to be coded as for weight loss and they won't pay those codes so its not covered? I'm trying to decide if I should go to my PCP for the diet or go to my surgeon's office. They offer a 6 month program for $750 that covers what is needed for the physician supervised weight loss. They also say that it facilitates approval to go through them (probably cause they know exactly how to document it). BUT, if I only had to pay my co-pay ($20 each time) to my PCP, I'd rather go the cheap route and go to her for the weightloss visits unless there is any other benefit to going to the surgeon's office. I suppose if I went to the surgeon's office they may be able to actually give me diet advice that is geared towards getting me ready for the post surgery diet.

Anyway, just looking for any of your experiences and thoughts on this. My other question is under what circumstances can you do a 3-month diet instead? I don't hear a lot of people mentioning that on here, but it is in my documentation from Aetna. Honestly, I don't care if it takes 3 or 6 months, but if I am to spend any time on another 'diet', I prefer that it be geared towards teaching me something that I don't already know... like tips/strategies/habits that I need to develop to support my success after the surgery so its not a total waste of time.

I have Aetna PPOS, and I did the 3 month program . I did not have to do a diet ,but I did get weighted once a month for three months (doctors ) office. I had been in Weight watchers for 5years(off and on ) ,and Curves for Woman .That showed I tried to lose ,and did at times only to regain . .I go in for my band on January 14TH ,the process went fast for me started Sept.28TH 2009 was approved Dec.24Th.

If you feel you need to do the 6 month program you do what you feel is right for you ,and that way you will be successful .I know that Aetna does help with weight lost Programs and I believe Weight Watchers is one of them ,also Jenny Craig .I think you get a discount on the programs and they can use that as weights towards (insurance approval) ,it did for me .I didn't need to do the 6 months and saved money that way ,it cost $39.00 a month and you have E -tools online to help with recipes and excise. Which ever way you go ,I wish you luck and hope you do well ,Best Wishes.:thumbup:

[PSJ71 0]

Hi Adagray,

I am wondering the same thing myself as far as if I will have to pay a huge office call visit with these supervised visits with my surgeon. My O/V amount is 30.00 each time to see a doctor, but not sure if this is the amount I will have to pay at each diet visit. I sure hope it is covered.

[adagray 1]

OK, I'm a little further along in the process now so I thought I'd give you an update. I decided to go through my bariatric surgeon's office for the 'weight loss'. My co-pay is $40 for each of these visits which I am totally fine with. I just didn't want to have to pay $100+ that a normal doctor's visit would cost if it wasn't covered at all. They also recommended that I go for the 3-month diet. They said it is something new to them, but if I was willing to see a therapist and exercise person for those three months, we could try to submit and see if it goes through. I figure may as well try. I can see a therapist who works out of my PCPs office and I have a friend who is a Jazzercise instructor and can help me w/the exercise portion. I will pay her what she would normally charge for personal training. There is no guarantee that this will get me approved in 3 months, but I figure it is worth the try. If not, then I continue on for the 6 months. I feel like its all worthwhile because the things I am doing w/the nutritionist, therapist, and exercise are all things that will help me in the long run anyway.

[PSJ71 0]

HI Ada,

I am glad you only have to pay 40.00. I hope I will only have to pay my required 30.00 office visits. I am still not totally sure.

I was a little bummed because I started the ball moving in November by having my bariatric coordinator appointment, also my blood work, chest x-ray, ekg, echocardiogram and stress test. Then, after I do that my employer sends a notice 2-1/2 weeks away from them changing all of our insurance. In this insurance, I went from not having a deductible to having a deductible, my copays going up, and not having to have a supervised diet to having to have one. So, I was upset when I found out I would have to do a 3 or 6-month diet, but actually since I have calmed down and thought about it, I am actually a little thankful because I figure this is going to benefit me in the long run by getting used to certain expectations.

I hope you have a smooth supervised diet and you are approved without hesitancy. )

Good Luck!!! :thumbup:

[Nooshie 0]

I have Aetna HMO and have to go through the 6 month diet. I will meet with my pcp tomorrow and will ask if the 6month visits are covered. Thank you for posting because I didn't even think to ask. I'll let you know what I find out.

[MacMadame 81]

I feel like its all worthwhile because the things I am doing w/the nutritionist, therapist, and exercise are all things that will help me in the long run anyway.

When I still thought Aetna was going to pay for my surgery, I wanted to do the 3 month version for exactly this reason. I figured I'd be learning about life after WLS and it would help. The 6 month diet, OTOH, is not only 3 months longer, but didn't have that "multi-disciplinary" aspect that would make it valuable.

In the end, I self-payed and didn't do either. But that's another story for another time.