Question:
I have Aetna Insurance

of their qualifications for having the surgery approved except the 6 months of supervised weight loss attempts, even though i have been on both slimfast and metabolife since February of this year they were not medically supervised.Does anyone who has worked with Aetna know if they will accept me just saying that i've been trying or will they still want me to go through being medically supervised? And do you think i should start seeing a nutritionist now? or wait, but if i start seeing a nutritionist now won't i have to wait 6 months before they will approve me. Sorry about the ton of questions    — Stacy I. (posted on August 12, 2002)

August 12, 2002
Don't know about Aetna, but when I started back in January, my surgeon told me about Cigna's requirement of 12 weeks physician supervised diets in the last year and suggested I contact my PCP then and start one. My surgeon's insurance clerk told me that if you can't submit documented evidence, most insurances won't accept it. While we did the 12 week program it gave my PCP opportunity to make sure her notes had mentions of all my co-morbidities and when we re-submitted her notes in April after the first denial, it was approved in late May. I'm having my surgery this Thursday.
   — Cathy S.

August 12, 2002
HI- I am in the appeal process with AETNA because I do have an 11yr chronicle of weight loss but AETNA wants 5yrs and didn't like the letter the PCP wrote. PCP sent a new letter and its in appeals as we speak. YOU NEED THAT LETTER. Good luck on your journey. Deb
   — Deb K.

August 12, 2002
I don't believe Aetna's site says a specific amount of time for Dr. supervised diets.. it just says a "history", so in my opinion, that means whatever you have! I have Aetna also and I did have two sources of Dr. supervised diets, but I did also list weight watchers, nutrisystem and slim fast on my diet history so they saw that I had MANY attempts! List everything you have and provide as much documentation as you can and you should be fine!! Best of luck!!
   — sunsect

August 12, 2002
Hi Stacy, I am due to have surgery in about 48 hours! I also have Aetna and began my process 2/20/02, less than a month after my brother passed away 01/25/02 due to complications of being morbidly obese. I was denied by Aetna 5/02/02 because they said I was overweight, but had not comordities (untrue, doctor had fax confirm. of 29 pages faxed to Aetna). So on appeal, my pcp wrote a 'medical necessity letter' with my attempts at weight loss supervised by him (2 attempts over a eight year period), all the meds I am on and the fact my brother recently passed from complications of being obese. When I faxed my appeal to Aetna, I included my pcp's letter, history of diet trials (medically supervised and on my own) list of medications I am on, a copy of my brother's death certificate, and a copy of his funeral services. Needles to say, I faxed it to them on 5/16/02, and was approved in less than 24 hours!!. So here I am, going to finally have the surgery on 8/14/02. A portion of the approval letter Aetna sent to My pcp, me and the surgeon states: "A board certified Internal Medicine physician who was not involved in the original denial decision has reviewed your Level 1 appeal. The information provided for our review included your appeal letter, along with your office notes (pcp) dating back to 1994 and the predetermination letter from Dr. Cribbins. The information submitted indicated that Mrs. Hoke has a body mass index (BMI of 58.4. She has comorbidities of diabetes and hypertension, and she has a history of failure of medical/dietary therapies..."Accordingly, based upon our review of the above information, we are reversing our original determination and wil now certify for a gastric restrictive procedure...." Sorry this is so long, I only mean to hopefully help you in your quest to have the surgery. Please email me at [email protected] if you would like more info. Good luck!!
   — Vikki H.

August 12, 2002
I had Aetna and got approved no problem. I was not on any supervised diets. I believe what my letter said was that I had "discussions" about the proper diet with my PCP. Not exactly what you would call a supervised diet, but I guess it worked! I never saw a nutritionist until I had surgery scheduled and approved. Good luck!
   — emilyfink

August 12, 2002
Stacy, I have Aetna US Healthcare MC I was approved on my first attempt without any history of medically supervised diets. I did document all the diets I had tried on my own. When I received my referral from my PCP he simply wrote on a script pad something to the effect of "I recommend bariatric surgery for this patient because she cannot exercise due to orthopedic problems". I also know of six co workers who were also approved by Aetna without any difficulties although I don't know specifics about their medical histories. Best wishes on your journey.
   — Kelly S.

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