Aetna's 3 month regimen - approved on first try

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KrisJoy, I sent you a message. :)

As of Jan. 1, I have Aetna as well. When I started my WLS journey, I had BCBS of NJ, and they required a 6-month diet. In my LAST month of that diet, I found out my insurance would be changing! So, I have done the 6 months of dieting and am submitting that to Aetna instead of the 3-month program. I should be submitted to Aetna next week (hopefully on Monday--only 2 days away!).

I am hoping my notes are enough, as they were written according to the requirements of my BCBS plan. I met with my PCP each month for 6 months, and she documented my weight and vitals, documented discussion of what diet I was following (counting calories and carbs), and documented what I was doing for exercise. She also documented at each appointment what her additional recommendations were for the next month (such as "instructed to increase exercise by 10%" or something similar). My surgeon's office staff seem to be very familiar with Aetna, and I know they wouldn't waste their time submitting me if they didn't think I would get approved, so I'm keeping my fingers (and toes any anything else I can think of) crossed!

Jill, I sending lots of good thoughts your way that you will get good news soon!  :)

Oh Jill....Good Luck!!  It sounds like you have eveyrthing you need with the 6 month diet program with your PCP.  The 3 month multidisciplinary program is qutie different and I've learned through this forum there are special letters you need to send with your approval, etc if your tring to do it in the 3 mo.  Everyone has been very helpful!  The one thing I do know from talking to an Aetna representative a couple of weeks ago is they do not go by the 3 months and 6 months, they go by days....90 days or 180 days.  So just make sure your 6 months has been over 180 days b/c anything short of that you will be denied from what I hear.

Keep me posted and let me know if you are approved!!!!  I'll be submitted to Aetna sometime shortly after my 90 days is up on Jan 12th!

I'm keeping my fingers crossed for all of us waiting for approval!!

Nan

Your right, Nan. Aetna says 3 months, but they really mean 90 days. Even 1 day early will get a rejection.

 Hey Bama Momam,

 Im new to all  of this. I go to my 1st dr's appoinment next week. I have atnea insurance. I would love all the info you could share with my please. I am really nervous and praying for the best. Thanks

Cant wait to hear from you

I'm new and I am hoping you could send me the Aetna info you sent in. It would help alot!

email   [email protected]
fax 603-401-8496

GOOD MORNING, I'M SOOOOOOOOO CONFUSED AS TO AETNAS REQUIREMENTS! my NEW SURGEON TELLS ME I NEED A 6 MONTH DOCUMENTED WEIGHT LOSS THE FIRST SURGEON I HAD SAID 3..I DID THE 3 MONTH SUPERVISED WEIGHT LOSS WITH THE FIRST SURGEON I HAD, I SAW HIS NUTRIONIST,EXERCISE LADY AND PSYCH LADY I THOUGHT THAT WAS ALL I NEEDED. THE NEW SURGEON I'M SEEING WONT SUBMIT THAT INFO TO MY INSURANCE COMPANY HE SAYS I NEED 3 MORE MONTHS. PLEASE IN PLAIN ENGLISH CAN YOU TELL ME WHAT I NEED? I'M IN TEARS I'M SO CONFUSED NOW...I'M GETTING DISCOURAGED AND THINKING THIS WILL NEVER HAPPEN FOR ME. I SAW AETNAS REQUIREMENTS BUT I NEED PLAIN OLE SIMPLE ENGLISH TERMS..I'M BEGGING YOU PLEASE HELP ME!