Question:
Has anyone ever been approved for gastric bypass by Aetna without medically supervise
diet? Does anyone have any suggestions on how to get a medically supervised diet without having to wait the 6 months that Aetna requires. — Tina K. (posted on April 29, 2003)
April 29, 2003
I didn't actually have proof of all of this...we had just moved to KC and I
was new with my PCP... she asked what I had tried... and wrote that in the
letter... so as far as records to prove it to Aetna no I did not have to
provide those... I have Aetna through work...
— MF
April 29, 2003
I got approved a year ago, and did not have any supervised diets. Although
AETNA did require for me then as well, i heard it is a little harder after
Jan '03- i guess they changes some things. But I did have my PCP write a
letter saying I've been under his care and needed this surgery. Worked for
me. Goodluck !
— Lezlie Y.
April 29, 2003
I was just denied last Thursday because of this very issue. It was
devastating for me, even though I mostly expected it. There is absolutely
no way around this criteria. None. Make an appointment with your PCP
immediately and have him document your weight every month. Sorry for the
brutal truth, it hurts to accept it as much as it hurts to tell it.
— Susan F.
April 29, 2003
Please go to my site here. At the end i posted exactly what the expert
doctor wrote who overturned Aetna's denial because of no documentation in
the medical record. Keep pushing-keep getting the denial so you can have
the external review look at it. As long as your doctor has written a letter
with all your attempts at diets. It sure seems from the letter I received
that they don't care what the policy says-they are looking for the medical
neccesity of the surgery. So, keep trying. My surgery is June 10th
— toni S.
April 29, 2003
Please go to my site here. At the end i posted exactly what the expert
doctor wrote who overturned Aetna's denial because of no documentation in
the medical record. Keep pushing-keep getting the denial so you can have
the external review look at it. As long as your doctor has written a letter
with all your attempts at diets. It sure seems from the letter I received
that they don't care what the policy says-they are looking for the medical
neccesity of the surgery. So, keep trying. My surgery is June 10th
— toni S.
April 30, 2003
NO, I did not have to have any kind of documentation. Although, I had my
insurance through my employer and my employers policy is NO EXCLUSIONS
WHATSOEVER, so if Aetna did try to pull that "diet history" mess
my employer would have stopped them in their tracks. My surgeons office
faxed over the request for surgery and within 4 hrs I was approved. Aetna
also has different types of policies within their insurance group, HMO,
PPO, POS, managed care, all of them do have different criterias. Hope this
helps, and good luck!!!
— gloriafb
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