Question:
I know Aetna requires a 6 mth diet but how does that work? 6 monthy visits to the
doctor with medical charts or one inital visit and 6 more months. If I started in July 29 when would my visits be up? — sadiebelle (posted on December 19, 2008)
December 19, 2008
From my experience with insurance (we have BCBS though) it is in your best
interest to call your insurance company. Ask to speak with your
pre-authorization department, because sometimes the customer service reps
don't always know every detail in your plan. Aske the pre-auth person
EXACTLY what documentation they want, making sure to get the person's name,
so that if you get conflicting information later, you can tell the
supervisor of that department who told you what. Document EVERYTHING! I
learned that the hard way during the last few months. If need be, ask your
primary care doctor to write a letter to your insurance company on your
behalf, stating that he/she has been seeing you for this amount of time for
weight loss, listing any weight loss medications you have been on, what
sort of success or lack thereof you've had, and whether or not he/she
thinks you would be a good candidate for the procedure.
You have to learn how to jump through their hoops to get what you want.
Sometimes insurance is a "game", so play the "game" and
win. Find whatever avenue you have to take to get the insurance company to
approve your surgery. Sometimes it's very frustrating, but it's worth the
fight. Best of luck!
— [Deactivated Member]
December 19, 2008
Suzie,
Hello, I think I can answer this for you as I am required to do the same
thing. What they require you to have is 6 months of Medically Supervised
Weightloss. Essentially what happens is that your doctor talks to you about
proper and healthy eating habits and possibly a nutritional diet such as
high protein and low carbs. You are required to see your doctor once a
month and they have to chart your weight, etc and follow up on your diet
regimen. If your first or initial visit for this was July 29th, then your
final visit would be no earlier than January 29th. It sounds very tedious
and time consuming but don't let that hinder your decision to improve your
health. You can do it! Best of luck to you and Happy Holidays. :-)
— Elizabeth J.
December 19, 2008
Your 6 months would be up January 29; however since insurance companies
want control make sure any diet is regulated by a physician and not someone
in the insurance industry trying to make sure they get their money's worth
from your coverage. As a previous post stated, sad but true in our
society, sometimes one has to play the "politics of the game" to
get what you want. God Bless and Good Luck,
vinnigirl
— vinnigirl
December 19, 2008
i have bcbs of Pa and had to do the same thing, my first visit was oct 28th
with the nut. which counted as one, 2.nov.3.dec.4. jan.5.feb and my last
was march 29th and i got approved with in 1 week of them recieving my
paperwork. my surgery was July 22nd, couldnt believe that i had to wait a
little over 3 months for my surgery, but it was here and gone so fast. and
I am down 75 pounds..yeah. So if yours goes as good, then dec. should be
your last visit.
— [Deactivated Member]
December 19, 2008
Yep, what Elizabeth said and your 6 months would be up in January. I
disagree with calling the insurance company because that can only frustrate
you further -- I've always suggested that folk let the doctor's communicate
with the insurance company because they know how they are suppose to write
stuff up and the correct codes and lingo. If your company included
coverage for WLS then you are covered. Almost every insurance now has that
requirement of 6 mth supervised weight loss -- via your primary care
physician and nope Jenny Craig and Weight watchers do not count. I had to
go every month just basically to be weighed in. My doctor put me on an
appetite suppressant and I didn't have to meet with a nutritionist. Every
insurance is different and every WLS surgeon is different. If you PCP
knows about WLS and is very supportive of you having the surgery --
CONGRATULATIONS -- keep them -- if not -- get another primary care
physician.
— the7thdean
December 23, 2008
I too have Aetna and had to do the 6 months supervised diet. My first
visit was in June 07and my final visit was December 07. You must not miss
a month or else you have to start all over again. I only lost 7lbs during
this time but they still approved me for my surgery. I was weighed every
month, blood pressure taken and had to tell what i was doing to help with
weight loss. I had an approval the week of Christmas. Good Luck
— lwilli59
January 10, 2009
When I went to my very first mtg. about Weight Loss Surgery, located at our
area hospital, they had an insurance specialist on hand to discuss
individual insurance questions. I have UHC "United Health care",
I was told that UHC and Aetna were the only 2 companies that required a 6
month Dr. supervised weight loss plan before they'd consider you for WLS.
The specialist took my information & sent me 6 forms (1 for every mo.
for 6 mo.) I was to schedule 6 monthly appts (can't miss one), and discuss
a diet plan w/ my Dr. He had to fill out the form monthly (***every line on
the form needed to be filled out. No line should be left blank. Every month
I faxed the completed form to the specialist, she reviewed it and either
kept it on file or let me know when there was info that was too vague or
anything she felt the insurance co. would scoff at). At the end of 6 mo.
she sent the forms off to UHC and we waited for approval. I am almost 11
weeks out now and am down 50 lbs. I actually only lost 11 lbs. during that
6 mo. but was told it didn't matter if I lost, they just wanted me to wait
6 mo. to see if I'd change my mind or give up because of the hoops they
were having me jump through. So typical for insurance companies.
Good luck to you....it is soooo worth the 6 month wait!
Laurie
— Laurie H.
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