Question:
How do I meet Aetna's new requirements, posted 1/17/03?
These are Aetna's new requirements: (1) the presence of morbid obesity that has persisted for at least five years; (2) patient has participated in a physician-supervised nutrition and exercise program, documented in the medical record which is: a. Supervised and monitored by a physician working in cooperation with dieticians and/ or nutritionists; b. Is of six months or longer in duration; c. Has occurred within two years prior to surgeryand (sic) d. Is documented in the medical record by an attending physician who does not perform bariatric surgery. Note: A physicians summary letter is not sufficient documentation. How do you meet these requirements? It seems that these may be impossibly difficult. Please share your thoughts. Thanks, Susan — Susan B. (posted on February 5, 2003)
February 5, 2003
first, have you been obese for at least 5 years? Second, go to your doc and
have him start you on a "documented" diet routine.You may have to
wiat the 6 months that they require. Have him send you to a dietician. Do
it now. THen apply for the surgery in 6 months. No other real way around
it. UNLESS you have been going to weight watchers/ jenny craig and have
that documentation that you can provide to the insurance company.
— Vicki L.
February 5, 2003
I wish I knew the answer. I'm in the same boat as you. The only thing I
know is that "my" AETNA doesn't even cover their own
requirements. That will be my argument if/when I have to file an appeal.
Since they do not cover the Dr. supervised/nutritionist diet, how can they
require me to pay for that out of my pocket before they provide coverage
for the surgery which my policy states that they will cover if medically
necessary.
— Carolyn M.
February 5, 2003
One more note. Please visit the following web page (which says it was last
updated 6/2002).
http://www.insure.com/health/obesity.html
This site mentions the requirements of AETNA which is the same as you
mentioned. Perhaps this has always been the policy?? We can only hope.
I'm currently on hold with BTC insurance department to check on this.
— Carolyn M.
February 20, 2003
My wife didn't have a supervised diet, but the doctor sent in his chart
notes on her for the last year or so - documenting how her Type II diabetes
is worsening and her pre-certification request was just approved today.
We've been sweating bullets the last couple of weeks waiting this out.
Just go ahead and send in what you have - while getting your doc to start
documenting your diet/exercise in the chart. The worse they can do is say
no and you try again in 6 months...JR
— John Rushton
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