Question:
Has anyone with Aetna been approved without supervised diet?
My husband really wants this surgery. However he has not been on the six months supervised diet. He has done weight watchers, Redux for one month, and has been going to my pcp for two months now. He is on Zenical right now and cannot take it. We would like to know is it to early for him to go for a consult. — Teressa D. (posted on July 13, 2002)
July 13, 2002
I have aetna us healthcare and was approved within 48 hours of my doctor
submitting his letter. they based their decision solely on what my doctor
wrote in the letter which basically just explained all the different diets
i had tried over the years. i wasnt required to show proof of a supervised
diet. i got my approval in february and had the surgery done on 4/9/02.
although i guess they could have changed their requirements since then.
hope this helps.
— Tami K.
July 13, 2002
Same here. Here's the letter that my surgeon wrote.
<p>
To Whom It May Concern:
<p>
The above captioned patient has inquired about Roux-Y gastric bypass for
morbid obesity. I am requesting a pre-determination of approval for the
above procedure. I explained the procedure to Mr. Rushton and told him
that the criteria for being a candidate are a body mass index of over 40 or
over 35 with co-morbid conditions. I believe Mr. Rushton qualifies with a
height of 5'4", a weight of 439 pounds and a BMI of 75. In the past
he has attempted an Exercise Program, High Protein/Low Carbohydrate, Slim
Fast, Protein Powder Drinks and Calorie Counting as well as Weight Watchers
program.
<p>
Mr. Rushton's secondary problems relating to his morbid obesity include
sleep apnea, excessive snoring, shortness of breath, poor circulation in
legs and feet and diabetes.
<p>
The procedure consists of placing vertical staples to create a very small
gastric pouch which empties through a narrow channel in the stomach. Next,
a limb of small intestine is created to bypass about 2.5 feet of small
bowel. The technique by which the operation works is to limit food intake
so that weight loss occurs secondary to food intake.
<p>
***That's the letter that got me approved...
— John Rushton
July 13, 2002
Yes, I was approved in a week and had no supervised diets. I hadn't tried
any medications either. Just weight watchers and my own thing.
— emilyfink
Click Here to Return