Question:
Has anyone had surgery with aetna ins since they revised their plan in April 2005 .
aetna always required a 6 months physician supervised diet. Now they will cover 3 months multidicplinary program. — Water Baby (posted on July 12, 2005)
July 12, 2005
I just submitted my paperwork a few days ago using the 3 months
multidiciplicany program. I will let you know what comes of it.
— *Malena* M.
July 12, 2005
What is the 3 month multidisciplinary program?
— Sharon2004
July 12, 2005
This is what is required for the 3 month program. I have heard from some
people that Aetna has declined them, although I have also talked to a few
people who have been approved. My doctors office has never had anyone
approved using this...
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:
Consultation with a dietician or nutritionist; and
Reduced-calorie diet program supervised by dietician or nutritionist; and
Exercise regimen (unless contraindicated) to improve pulmonary reserve
prior to surgery, supervised by exercise therapist or other qualified
professional; and
Behavior modification program supervised by qualified professional; and
Documentation in the medical record of the member's participation in the
multidisciplinary surgical preparatory regimen. (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.)
— *Malena* M.
July 14, 2005
I was just approved last week from Aetna. I am working with a great
bariatric program in Ohio that really makes sure you have everything you
neeed. You MUST have 5 years weight history on office notes (not in a
letter), 3 months multidisiplinary weight loss program or 6 months physican
supervised weight loss and a letter of medical necessity. I had everything
in order when my surgeon's office submitted the paperwork and I had
approval in about a week!! I was shocked. I would be happy to answer any
questions, feel free to e-mail me.
Shellie
— Shelld
July 15, 2005
I just got approval from Aetna yesterday. I was told by Aetna that it is
actually much easier to get approved if you follow the "older"
criteria then the 3 month plan. Aetna actually told me to go on their
website and do a search for obesity surgery and the first result will give
you a complete discription of exactly what Aetna wants if there is either
no exclusion or an exclusion stating med. necessary. I took that list to
my family physician (thats who did my 6 mo diet) and he followed that. I
only sent in my six month diet, a letter of med. necessity from my family
dr. which included the 5 year obesity clause (no documentation), a letter
from my ortho. dr., and there was NO problem. Follow what Aetna gives you
and you should be fine.
— Mandy S.
Click Here to Return