Aetna POS

How did you satisfy Requirement 3 of Policy 0157? This is the part regarding unseccessful weight loss attempts. How did you document that? What type of information are the looking for? I posted this earlier on the main board, but I really want to get som info from patients from St. V's.

Most insurance companies want to see doctor/dietitian supervised weight loss program. Both St Vincents and St Francis offer these types of programs. Some insurance companies will accept 'popular' programs like Jenny Craig or WW...but usually it has to be under the care of a doctor along with a dietitian. Good luck on your journey!!!!

call and ask them for one thing...make sure you are getting what they want...one thing cigna was good at was asking for a 26 week diet..and after someone had done 6 months or 24 weeks they were still denied..they wanted that next 2 weeks..so you may call, and you may call several times just to see if you get the same info..i did not have stv but i dealt with denials and i also run a board on yahoo about cigna, i mostly now watch and make sure everyone behaves, though i still support them...i know the new people have other problems maybe than i did with the ins co...you would think but it is still about the same...csr lie, are not trained to tell the truth or to know the truth....and the games the ins co likes to play...

I have anthem so they may be different. There requirement is 18 months of consecutive monitored weight loss attemps. I had my dr. write a letter that detailed everything we had tried over the last 5 years. Then I called anthem and asked them for any forms that the MD had to fill out. There was a surgeon verification form. One of the questions was, has this patient tried 18 months of consecutive diet attemps. My MD marked yes. I had not been in his office every month for 18 months, but he new that I was constanly trying. Also on St. V's diet history sheet, I started at the top with the present time and worked down in order with no time lapses for 2 years of attemps. I.E present - June 2005 South beach, June 2005- June 2004 weigh****chers and so on..... With the surgeon verification form filled out before the packet was sent in, I did not have to send in medical records at all. Hope this helps. ~ Sarah

Melanie, I am also with Aetna POS and with Dr. Gupta at St. V's. When I started this journey for approval for Lap RNY back in 05 I was insured with Cigna. They required a 6 month physicians supervised diet and excercise plan, so I did that. When I discovered in Oct 05 that my insurance would be changing to Aetna on Jan 1 06 I had to modify things a bit. I continue on with my physician supervised diet. Make darn sure your doctor notes in the med record ALL aspects of your attempt, increased excercise, behavior modifications, etc., Also note that Aetna requires your working with a Nutritionist as well, referred by your PCP. Also in my submission I went back to childhood and dated and detailed EVERY SINGLE weight loss attempt I've ever made - a pretty huge effort considering the first time I tried weigh****chers was when I was 7. The end product was 9 pages long in #12 font. When & where I could I supported my accounts with weigh****cher records/receipts and jenny craig receipts. And of course, medical records dating back 10 years - over and beyond the 5 year requirement - establishing a BMI of over 40 and various test results to support health concerns. Print out the policy bulletin and use a highlighter to complete your list. best wishes, jen