Question:
Why does Aetna require documentation from a medical professional that a diet
Why does Aetna require documentation from a medical professional that a diet has been attempted within the past 2 years. My last attempt that was documented is 3 years old. Has anyone had any experiences with Aetna PPO? Any information at all is helpful. Thank you for the guidance and support. I am so afraid I am going to be denied because of this. I am just hoping I don't have to do a 6 month medically supervised diet, but if I do I do and I will do whatever it takes to have this surgery. — Sara A (posted on June 29, 2004)
June 29, 2004
I am not sure how they decided on that policy, but that policy is why I had
to go self pay. My medically supervised diet was three years ago and they
denied me repeatedly. :(
Paula
— Paula R.
June 29, 2004
Hi Sara;
I also have Aetna. I had my last supervised diet with a Doctor several
years prior to their rule and I was approved. I just sent everything I had
and stayed on it. I also took diet pills supervised several years back and
got copies of my records and sent them in. Much more documentation than
they asked for. I think they just want to make sure we are not jumping on
the band wagon so to speak. Get everything you can together, send it in,
wait about 1 week and start calling. Try to make a repore with someone in
the office and let them know how important this is to you. I called about
everyother day and it took three weeks to be approved. Good luck!!! Hugs;
— Barbara S.
June 29, 2004
Hi, Sara. I have Aetna Managed Care POS and I am nervous about the exact
same issue. I have OPTIFAST records from 5 years ago. If you go online to
the Aetna website, look up the "clinical policy bulliten" on
obesity surgery. If you look closely, you'll find that you have a choice
between the 6 month medically supevised diet OR the 3 month pre-surgical
regimen. This sounds much more do-able if I'm initially denied- don't you
think? Good luck and keep going even if you're initially denied.
— Cara M.
June 29, 2004
Hi Sara, I was approved from Aetna in Feb after having to do a 6mo
supervised diet..I did the diet and after the 6mo I was approved no
questions asked..all I did was each month went to my pcp got weighed in and
also talked about what things have been going on with eating losing so
forth..I also went to a dietian 1 time and that was it...I didnt have
problems getting approved and I have Aetna ppo in Washington State. email
if you have any other questions about getting approved through Aetna.
— por2geegurl
June 29, 2004
My advice..humble as it is....Start a supervised diet ASAP
I went to a dietician and a behavioral therapist for 6 months, also had to
have my exercise program supervised....
What I did was sign into the Y and then sign out and they initialed
it...Best of luck to you..It is so worth all the hassle..
— Kathy S.
June 29, 2004
Most insurance companies are putting forth some sort of requirement for the
patient to have a doctor supervised diet attempts, whether it is 2-26 week
diet attempts or what your insurance company is requiring the documentation
for a diet attempt w/i the past 2 years. Even BCBS PPO of IL is starting to
require this. The insurance companies want to see if you really have tried
to make every effort to try and loose weight before they pay for a very
expensive operation. The medically supervised diets are also to see if you
can follow through on the new lifestyle that you will be required to do for
the rest of your life. No offense but some people think that WLS will be a
cake walk afterwards, but it is one of the hardest things that I have ever
done. I mean keeping up with the exercise and watching my diet to make sure
that I reverse 40+ years of bad eating habits is really hard. If you have
to go through with the 6 month medically supervised diet use it as a time
to really start educating yourself to get a handle on why you overeat and
start reversing all those years of bad eating habits. I know that this is
probably not the answer that you wanted but I really wish you all the best
and good luck.
— ChristineB
June 29, 2004
If you have comorbidities your surgeron and pcp can prempt the 6 months if
the 6 months wait will make you worse. The ins companies have to have some
control over this surgery and that is all they have come up with for people
who need the surgery. go to your pcp now tell him you need a diet plan now
if you have to wait the six months will go quickly you have to visit your
pcp 1 time a month for weight to be in your chart. Aetna is serious about
the 6 month thing but your dr can fight it by convincing aetna you can't
wait.
— robinm
June 30, 2004
Hi. Sorry to tell you, but yes, you will have to show doctor documented
proof of a diet for the past 6 months before you will be approved from
Aetna. I have Aetna (my surgery is in 14 days), and that's the way it is
accross the board with Aetna.
Spyder
— SpyderS
June 30, 2004
I have Aetna PPO too here in Ky. I had started my 6 mo diet in May 2003,
(when they had the 6 mo diet rule) and then learned about Aug that you
could submit for insurance approval after 3 months, but would have to wait
till the 6 monthe diet period was up prior to having surgery. (This info
was per thei website, AND IS A JOKE). I submitted for the surgery after the
3 month period, and they req add info at 4 months (which I sent). Then they
denied me for not having the 6 monthe diet period. SO I appealed in Nov
and finally got approved in Jan 2004. Took me 6 months to get approved.
Don't mean to be negative - just telling my experience. There is a
"WLSAETNA" or "AETNAWLS" board on Yahoo that might be
of help. I got info off of there for awhile. A FEW people off of that
board AFTER me DID get approved after only being on supervised diet for
only 3 months. Get on the Aetna site and they can tell you EXACTLY what is
needed to get approved now. It was very helpful to me. One last thing, I
have heard a lot on this board that Aeta is very good about approving once
you have all of your ducks in a row. Open RNY 1/30/04 - 352/287/140 GOOD
LUck in getting approved. If you need additional info, e-mail me privately
and I'll give you more info.
— bufordslipstick
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