Aetna Insurance

I was reading on the requirements for Aetna and one of them is 2 years of medical supervised diets. Now I do not have this even though I have been on a few diets in the past 2 years I have never been on a doctor's diet. Will this cause Aetna to not cover the surgery or will I be able to get around this? Has anyone else been in this situation? I made my appointment for my consultation anyway just in case. I really want to have this surgery and if this one and only thing is stopping it I think I'll scream. I want to be comfortable for once in my life, I want to love myself (I haven't in a long time). I have been overweight for a looong time and nothing seems to work. My appointment is November 5th (that seems like forever but I know it will go fast). Please let me know if anyone has Aetna Insurance and has been thru the same situation or if not what else I can do. Thanks in advance!

Im here to assist!!! Ok...There are several different choices: One of what Aetna seems to require is 5 years worth of doctors documentation that you have been morbidly obese. IE: when the nurse weighs you and they write it down. THEN...they need 3 months worth of a doctor documented weight loss program and exercise program a (Multidisciplinary Surgical Preparatory Regemin) that would include PMRI. I personally did weigh****chers and each and every month I went to the doctor and she documented my progress. I also was fortunate enough to have a gym here at work and I had a work out schedule and the fitness director oversaw my progress there as well as the doctor. I would suggest to join a gym or curves and have a professional document your progress (which they require) I gathered aaalll of my documentation once completed - (continue the programs up until surgery). The documented weight loss program is very important so is the exercise program. Once you start getting your appointments rolling... the psychologist and nurse practitioner along with the endocrinologist seems to have been cracking down on whether or not you are in a nutrition program and are ready for the ability to handle a new "diet" so to speak. This way if they recommend that you do that you can already say that you are doing it which may be very beneficial to you and speed things along. So start now If you go to Aetnas web site...right there on the main page click on Doctors & Hospitals - slide over and down to Clinical policy bulletins - Medical - scroll down and click continue - and click on Full alphabet of clinical policies - clik on Obesity surgery - now if you read through the first part: Policy 1. then find Selection Criteria(underlined) look at number 4. if you read the paragraph it states you must do EITHER criterion I picked criterion b (Multidisciplinary Surgical Preparatory Regemine) read the paragraph for b and follow that. Remember that you must have that diet and exercise documentation the other regimen is the PMRI doctors the lung doctors, the psychologist the nurse practitioner the diet class the endocrinologist the pulmonologist etc... be sure to write a letter to Aetna and state in their own words which criterion you did and what steps you took to follow that criterion. OK I know this was soooo long but this is what I did and they approved me. This is my personal experience... please do more just in case it is not enough! Dont take my experience to be a guarantee of getting approved. Definitely review and review again. I wish you the best of luck. If you want to talk to me more about it you can definitely send me an e-mail. Definitely start a nutrition program right away if you can ;0) There is no way around that. And research, research and research some more. Best Wishes on your new journey! Elizabeth M -49lbs

Well, regardless, if I were you I would make an appointment with my primary doctor asap and have him set me up on a supervised diet. November is 6 months away and a surgery day will more then likly not be fore 6 months after that. By then, you can have a years worth of Dr. supervised dieting under yoru belt and documented and that may make a diference one way or another. If they do make you hav eone for 2 years then you will be 1/2 way there.

Hi Eileen, I don't have Aetna insurance but my insurance company requires 6months worth of doctor supervised diets in the past two years, I fought it for awhile but just gave in and went to my pcp and she put me on a supervised diet and exercise program I have to keep a food journal. My first appointment with Dr. Wynn was November 14, 2003 and when I get this diet done it will be November, so I have come full circle. Dana