Question:
What do I need in the letter? From me/doctor?

What kind of information do I need in this letter? Does the letter need to come from me or my doctor? Please help me?    — Jean M. (posted on July 19, 2005)

July 19, 2005
I can tell you that the letter my doctor wrote for me listed the diets I have tried but yet failed at, along with her recommendation of the surgery and I got approved :)
   — moodyfaerie

July 20, 2005
Hi Jean - I have Aetna also. First it depends on the type of Aetna plan you have. Also- you need to look on their website - see bulletin 150 or 149 - it was updated as of 4/05. This is a bulletin specifically dealing with WLS & Lap Band. Print it out - because these are the requirements you will HAVE to meet to be approved for surgery. THEY DO NOT automatically approve you for this surgery. You will notice in that list- it says at least 6mos of medically supervised weight loss- and at least 3mos must be consecutive. If you do NOT have that requirement- you will be automatically denied. Then there is the "exclusion" to your policy. They tried to tell me back in Feb, that my company HAD to have a rider to include this WLS surgery. You might want to find out when your policy was last renewed and do you have a rider ? My company called Aetna (its a small company) and were told by their company rep at Aetna- they did not need a policy rider But then I heard that all new policies effective 1/2005 would have to have one. Our policy is up for renewal 10/05 so I aimed to get my surgery done before that. ALSO- your surgeon- NOT your PCP submits you for clearance for surgery- and its better that he does. You have to have medical clearance and several fields of testing- like endoscopy,nutrition, etc if you are seeking RNY surgery. I think there are similar but less tests for lap band. If you have not picked a surgeon- I highly recommend Dr. Garber and Dr. Holover. Their staff is efficient and on the first consult- the Dr will tell you exactly what you need to do- to get approved by Aetna- and that includes the letter your PCP has to draft and what is necessary in that letter. your profile didn't say where you are in the process- if your doctor has to re-draft a letter to your surgeon - then you better make sure you have the 6mos of weigh-ins to be approved. When my doctor submitted my claim - they came back asking for that letter- which included my history for the last 6mos consecutively. So that should give you an idea of what Aetna is looking at now- because I couldn't find anyone who was recently approved by Aetna-this year- but I have been told by my PCP they were approving if the requirements were met .
   — nybabe