hello ladies, I have a ?

I just moved here from the state of Washington. We are on insurance now rthrough aetna. I am kind of worried about my letter. I didn't have a doctor during the 5 years I lived up there. yes I would go to a clinic two different ones. One of the clinics did state I needed to lose weight but that was 4 years ago. While pregnant I only saw my ob when I got sick not a solid doctor history. My endo wanted me to keep coming back to him but with 200 a pop he lasted two visits. So I don't technically have a solid 6 months of trying via doctor. But I have tryed through weigh****chers. and every other diet fad that came along. You all know what I am talking about. So now I am going to be looking for a doctor here in indianapolis. You think I shouldn't try to get approved until 6 months of trying through this doctor. Or could all my records show how overweight I was the last 5 years do it. Has anyone else gone through this? Anyone else have aetna? would they approve me quicker if I go out of network? I hope some of you could answer some of my questions thanks Robin

HI Robin, Welcome to Indiana...your my next door neighbor, I'm over here in Mooresville! According to my insurance I had to have so many years of doctor regulated dieting as well, but I had several comorbid conditions prior to surgery that got me past that requirement. Some insurance companies are sticklers, and others might be a little bit flexible. Do you have any other medical conditions that might help them look past your situation? Perhaps that might be in your favor!!! Best wishes, and hope to meet you soon!!! You'll have to come to the support groups and check it out...it'll be my first time on Tues, Jan 17th at 6:30 pm!!! Take care!!! ~~~Shari

Hey Sherri I am in Mooresville too.. actually out by Andersons Orchard but I was raised in Mooresville.. The clothing exchange is January 21st at Mooresville Free Methodist Church.. 20 Star Lane.. Go down Indiana St to County Line. turn Right and it is on your RIGHT hand side about a block or so. Linda

first off i doubt they would approve you any quicker going out of net work....call your member services number on the back of your card see what they say...my pcp is all for wls, but he is also on post and 13th...there are ways around these diets and i know gary would be able to let you know if he could be of any help and he may have advise for you anway..

Hi Robin & welcome to Indiana & "home", You'll find loving, supportive people here. I have BsBc, & had to go thru a 14 mo. with supervised weight loss thru my PCP.(my Dr. put me on meds. as well.I only lost 15# in a yr. & had major health issues that were complicated by my weight.) I also had to attend Support Groups & get the paper that states you attended sent in to the Ins. & my Surgeon who did my RUNY. (Oh, I also continued with my Therepist during that time to present, who sent in an approval letter for me. ) It did take me alot to get this surgery, but I'd do it ALL again in a heartbeat!!!! I will be rooting for you, & hope you can find a PCP who also approves of & agrees to support you in your decisions. I wish you a great journey, with great results! (((hugs))) Ellen

Hi Robin, Welcome to Indy! I wish you the best of luck. I have Aetna and just got approved after 1 appeal. I believe they always follow their clincal policy bulletin's pretty closely for surgery approvals. Please go to my profile and read what I went thru to get approved. I would highly suggest finding a physician and getting started NOW w/supervised weight loss attempts. I think you will find that most insurance requires 18 months so, 6 months isn't all that bad. Be certain your PCP documents EXACTLY as Aetna demands or they will deny you. If you are unsure go to Aetna.com and use the drop down for the clincal policy bulletin's on WLS (it is #157) Also, I was told none of the weigh****chers or many other diet programs I had been on counted as physician/dietician supervised attempts. They require a nutritional consultation as well. Again, best wishes and please don't hesitate to contact me if I can help. Lisa D.

I agree with the rest. Pick your surgery center...both St Francis & St Vincents have physician monitored weight loss programs to help patients with their pre-surgery weight loss programs. I have Federal BC/BS and this year they have started paying for nutrition counseling...the co-pay for us is $20 a visit...this is a great new benefit. I wish all insurance companies would back up their advice to have weight loss programs since they are so quick to make people do it prior to approving WLS. Good luck with your journey!!!