Question:
What should I do next, got denied by Aetna HMO?
Just got news from my PCP that I am denied with Aetna. Aetna wants 6 month supervised diet. I already have 6 month supervised diet with my PCP but Aetna wants it to be with Nutritionist. What should I do? Thank you — JuliaV (posted on March 4, 2004)
March 4, 2004
Last year I had Aetna insurance. I went right to them and had them find me
a nutritionist in network.
— Sue C.
March 4, 2004
Appeal but in the mean time..go to a nutritionalist and get started. I also
saw a behavioral therapist for 6months.
It is soooo worth the wait.Take this time to get in the best possible
mental and physical condition and best of luck to you.
— Kathy S.
March 4, 2004
Go with an appeal. I have Aetna HMO and they approved me in a week. I had
no supervised diets...just a few talks with my PCP on nutrition. If your
PCP wrote a letter, check on how they wrote it. Definately appeal though
because sometimes it seems what kind of mood the person who reviews it is
in.
— emilyfink
March 4, 2004
Contact Obesitylaw.com, Walter Linstrom. That is what I did. I went through
the exact thing that you are! He'll write an appeal letter that they can't
refuse!
— Jeanne S.
March 4, 2004
I have Aetna HMO and was denied the first time. I did my 6 month
supervised diet, re-submitted and was denied again because I didn't consult
a nutritionist. However, my original denial letter didn't say anything
about a nutritionist, so I spoke with the doctor that denied me and he said
if I could fax him the original denial, he would change his decision. He
changed his mind. Mind you, this wasn't without a battle and talking to
several people at the insurance company before I talked to the doctor.
Julie
— Julie S.
March 5, 2004
Your diet doesn't have to be supervised by a nutritionist, you just need to
see one and make sure your PCP gets a copy of the nutritionist report and
notes it in your medical records that you seen one. You also need to be
"prescribed" exercise (have pcp put something in your records
regarding exercise). In certain situations, a psych eval is also
required.
Here is a link to Aetna's current requirements. They seem to change every
few months or so.
http://www.aetna.com/cpb/data/CPBA0157.html
Good Luck
— Carolyn M.
March 5, 2004
Hi there,
I had exactly the same problem with Aetna, and my PCP didn't count for
supervised diet. I talked with a customer service rep @ Aetna who told me
that Weight Watchers counted, so I joined. When Aetna wanted to deny me
again, I referenced this call and the name and date of the person I talked
to, and then sent in copies of my W.W. book to show I had been going and
working the program. I lost a whopping 12 lbs. over 6 months, but it did
get them to overturn their first denial. So check on that to see if it
would qualify. I found the only thing I could do was to comply with every
detail they wanted. I also scheduled a monthly visit with my PCP and had
her code it as obesity related. Aetna wanted those visits for 1 year, so
if you already have 6 months with yours, continue to go monthly for the
next 6 as well as to W.W. or to a nutritionist. They are looking for ways
to deny us, so I was diligent in following all their rules. It worked!
Had my surgery almost 3 weeks ago after fighting with them for over a year.
It was worth it. Good luck and keep fighting. They really hope we will
go away after they throw up so many roadblocks. Hope that helps some.
Pat F.
— Patricia F.
March 5, 2004
Try emailing gary. [email protected] his advice is free. You
may not even have to hire anyone.
— superellen
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