Question:
Anyone been sucessful in being approved for surgery without the 6 months diet?

Has anyone been approved for WLS with Aetna's new requirements. Is Jenny Craig or any other diet system been approved for the 6 month supervised diet?    — Barbara S. (posted on February 24, 2003)

February 24, 2003
I had 3 weeks of WW and a few yrs later 3 months of Dr supervised. But that is all. Not 6 consecutive months (or even 6 months total.).
   — Jamie M.

February 24, 2003
Not all insurance companies are alike in this requirement. Even different employers with the same insurance carrier can be different. Usually, if they want supervised weight loss attempts, they mean physician supervised. Call and ask what they require. If they do want 6 months of physician supervised attempts and won't accept Jenny Craig, make an appt. with your PCP for as soon as you can get in and tell him/her what you need. They can start documenting now that you are under their care. The 6 months will go by before you know it.
   — garw

February 24, 2003
I heard that AETNA changed their requirements a bit, but I thought the 6month supervised diet was always a part of what they wanted. Either way, I was approved by AETNA PPO last May for my surgery. I'm 23, BMI of 42 and didn't really have any co-morbs. I was never under the care of a doctor for a diet, persay, but he did write a letter saying he believed the surgery was medically necessary. I also had about 6 years worth of diets and exercise programs and gym memberships, including Weigth Watchers, LA weight loss, Atkins, my own diets, and 3 different gym memberships. Hope this helps, and goodluck on getting approved!
   — Lezlie Y.

February 28, 2003
We have a gentleman in our support group that used the Lindstom's at the Obesity Law & Advocacy Center http://www.obesitylaw.com to resolve the weight loss Hx issue with his insurance. Here is the Insurance portion from his AMOS profile: BCBS, Health Options Have been denied after first letter. Reason given was failure to document 12 months of doctor supervised weight loss. Working with lawyer to prepare appeal. The Obesity Law & Advocacy Center was a great help in getting insurance approval. They were very informative and their fees were reasonable. If you are denied surgery by your insurance company I would recomend Walter and Kelly Lindstrom to prepare your appeal.
   — victoriandove

March 9, 2003
Aetna will accept any sort of proof of diet programs like jenny craig or WW, or OA. The issue of the dietician is something else again. how Aetna deals with you varies considerably by area of teh country. For example, the requests of patients in the SE go to Alpharetta, Ga, which is denying ALL requests for precert on the first request. If you can get a live person on the phone, you find out that they don't have good internal guidelines for what is meant by the new requirements for the dietician. Apparently, if you can get a referral for that from your pcp, and you go, and get a report, that counts. The medically supervised diet attempts are fairly fluid, too. If your pcp prescribes meridia or Xenical, that counts. If you see a diet pill doc for a couple of months, that counts. This process si so drawn out that you pcp can prescribe for you, and you will meet the requirement by the time you get the other stuff done - psych eval, etc. Good luck, Susan
   — Susan B.

October 23, 2003
I had no problem what-so-ever Aetna was awesome.
   — Tee P.

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