It sounds like you have everything under control!  I would definitely check with the MD from the 90 day program and ask if they are requesting your past 2 years medical records because you will need to submit them with your paperwork in order to get an approval by Aetna.  And make sure your BMI did not drop below 40 in that 2 year history !  They will deny for this also.  (or BMI of "35-39.9 with co-morbidies. 

But yes, definitely get your medical records to whomever is going to submit for approval.  Not sure if the MD from the 90 day program automatically does that or if it's something you have to initiate.  Sounds like they have a good program in place though for meeting the requirements!

so its still aetna who approves or denies???  I am just trying to come up with some reason this is occurring... still waiting for the letter... : )

It is TOTALLY worth it.  I was denied for surgery because my surgeon's office submitted my paperwork to soon.  I too was doing their 3 month multidisciplinary program.  My surgeon's office submited the paperwork thinking I had completed it with my PCP.  I had not and was denied.  I finished the 3 month MD program, appealed, and won.  I had surgery in March 09 and have lost 160 lbs.

A friend of mine was denied by Aetna also.  Reason being 'lack of proof of obesity for 2 years'.  I helped her with her appeal and she was approved and had surgery in Jan 2010.

My daughter was also denied.  I appealed for her, and she won!  Had surgery this past May and is down 78.5 pounds.

So yes, it can be quite discouraging to hear all the stories of how Aetna is so hard to get approved, but basically, if you meet all of their requirements in their clinical bulletin 0157 (I'm assuming you have that already) you will get approved.  You just have to make sure all of your T's are crossed and your I's are dotted!  And if you are denied, get the reason why, and prove to them what they need to see.

One thing to keep in mind, it is not a 12 week program according to one of the Aetna appeals team member's I talked to.  It is a 90 day multidisciplinary program.  The wording when I was getting approved said 3 month multidisciplinary program.  He said this means 90 days!!  No less or you will get denied.  So make sure your first appoint and your last appointment with your PCP are at least 90 days apart!

I will PM you if you'd like a breakdown of everything I did to get approved.  Also, when talking to the Aetna representative, they stated the importance of the 'behavior modification' and that being documented with your PCP.  So make sure you are meeting all of the requirments as stated in the 0157 bulletin.

Good Luck to you!

Nan

Well, went back to the doctors today, so that I can get another months worth of phydician supervised diet on the books, just trying to do anything I can to continue to gain the paperwork neeed.  I am trying to keep my chin up - but its not easy.  As I do not have the letter, I cant tell what the denial is for, but I will wait for the mail and as soon as I begin in, do the next steps.

My company is self insured, so I am not sure how that is playing in - so I am trying to investigate that...

thanks for all the well wishes!

Maria

They really had no valid reason.  Said they didnt receive some my labs and didnt see that i was on Statins.  My Dr sent over 106 pages and was very thorough.  The surgeon says they are just trying yank my chains it sounds like.  Pretty frustrating as I am ready to be on the losers bench.