Insurance Coverage- I was scared to find out.

Sep 18, 2009

Well...  I checked my health insurance website (Aetna), and found out that I didn't have to do the six months weight program, but I do have to do the surgery prep regimen.  The site also said this didn't actually mean the surgery would be covered, and i was concerned about my particular plan having some type of rogue exclusion, so I called to follow-up. After holding for 15 minutes, the very nice young lady came back on the line and asked if it would be medically necessary.  "Ma'am, I'm huge,"  I replied with a smile in my voice. "I would not be doing this for cosmetic reasons".  Back on hold, and she came back to tell me, this surgery would be covered on my plan.  I feel better going to this informational session knowing this.  Thanks to all of you, I already knew what I might have to do pre-op.  This might be fairly easy with Aetna.

Stop here: Boring part is for me and those who haven't really looked into it. :)

1. 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.)
       

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