aetna ppo definitely make it hard to get a revision

Just re-read the letter from the bariatric clinic of what i need to do....and honestly it will be a daunting task i have to meet with a behavioral specialist....do an excercise regimen program supervised by a excercise therapist or other qualified professional. I will also have to be put on a reduced calorie diet by a nutrionist or dietician and this must occur within 6 months prior to the surgery.  So how can i get this all done? I have a child who goes to therapy twice a week i work 40 hours a week and i have to also do all of the above just to get a revision....Has anyone seeking a revison and has aetna ppo did you do this? They honestly make you jump threw so many hoops to get this revison surgery and once you do all this will u even qualify? they can still deny. Not even sure what are the out of pocket costs for all this. I will have to join a gym and get a trainer to for the excercise portion. co pays for the behavior specialists and for the primary doctor who has to supervise this whole thing . In all honesty they know a lot of folks can't or won't do this so they make it damn hard to jump through the hoops.... Can I do this? Should i just keep up with tracking my food and join a gym to get what i need  and for go all the things i need to do just to get this done?  I know if i hunker down i can do this but with work and my child's therapy i will literarly be going somewhere everyday taking time off work to see someone on a weekly basis at least for 3 months to show im serious....can i take this on? Sorry for the ramble .....

Hi,
Everything you have listed is pretty standard stuff. Join Weigh****chers online. You can start tracking your food imediatly. Can you join a gym and go while your child is in school of durrig your lunch hour? I am in the process of seeking approval for revision from RNY to DS and while these were not requierments I started WW 9 months ago and documenting every attempt at weightloss. Hopefully I will be approved.
Best,
Whitney

My doctor told me that if I am not dedicated to the hoops it will take to get the surgery, then I won't be dedicated to the surgery itself. He talked about how people get denied and cry about it for 6 months but then they have lost 6 months doing nothing.  You are going to need a gym after the revision to be successful.

Yes, they can still deny you - but the bottom line is, if this is what you want you have 2 options: do what they are asking or pay for it out of pocket.

If they deny you - you are out the money from copays, but hopefully the money spent on nutrition and the gym will be beneficial.

Best of luck to you!

This is 100% normal. I didn't have to do this bc I had a revision, but, it depends on the plan.  I had Aetna PPO and my revision (BOB) was approved right away without the 6 mos weight or the shrink.  

But, I don't have issues with this.  Be glad you have an insurance that will pay. Aetna makes 1st times and revisoners do this, its 100% NORMAL, EXPENDED AND WARRANTED.  Be glad you can even get a reviison with the new wording in polocies that says "1 WLS per lifetme"

To Aetna, you are a failure and they want to make sure you know whatr you are getting into so they don't have to pay again.

Based on your OP, is it aetna ppo or your clinic making the demands?

I too am being put thr the hoops. First by the clinic, even though they have been helping me thru 2.5 years on medical problems. They seem to forget all the medical issues, make you see a behavioral specialist for 6 weeks or more and than make you start over as though you never had surgery (or the medical problems).

Second my insurance now has a 1 in a lifetime WLS put into place. With much fighting they are allowing me to go thru the process a 2nd time. But, still can deign me. One person just got approved with medical issues. So I now have renewed hope.

Now, the clinic has informed me that I can go thru the whole thing and they don't have to approve me even if the insurance does.

First off thank you all for the responses.  I contacted the clinic yesterday and spoke to someone in the insurance dept...I had questions regarding the steps i had to take to get a revision as the steps appeared to be what a first timer takes to get the surgery for the first time. I explained that i was a revision 11 yrs out  from having a rny and  if she could review the policy again regarding revision surgery as i know the requirements for a revision may differ from when u are attempting to get the surgery.  After reviewing it and reading it to me it does appear that i would not have to do most of the things that  i listed in the previous statement all that will be needed is proof my bmi has been in the obese range for 2 yrs or more proof of diet history and  a copy of the medical report after i have my endiscopy showing the issues i suffer from....hopefully this will get me the approval i seek.

I am also in the process of getting a revision. I have tricare who also has a 1 WLS per lifetime.  I was denied and ask the Dr. to resubmit. The nurse said she was doing this last week. I sent a copy of the procedures they cover as he originally requested a DS which is not covered by Tricare.   Keep us posted on what you find out with your insurance.