Nervous about Aetna letter!

Hello Everyone, Today, I received a letter from Aetna indicating that they have received a request for my surgery on August 16th. The letter says "In order to complete the review and make a determination, additional information is needed: 1. A letter of medical necessity from the specialist office. 2. Office notes from the last 2 years from a physician supervised nutrition and exercise program. Is this standard? Are there any Dr. Irgau patients out there with Aetna *****ceived the same letter? Will Dr. Irgau's office handle everything? Thanks, I'll be waiting for ANY information from you! Angie

Hi Angie, I don't have Aetna buuuuut, I would recommend you try and get the papers in order ( and make double copies cause things get lost ) Call Dr. Irgau's office tomorrow and ask them if they plan on sending a letter. In the meantime call your primary ( and any other Dr. You may see on a regular basis ) and ask them to write the letters also. Offer to pick the letters up that way you can make copies and don't have to sit and wait on the mail hoping someone mails them in a timely manner. While you have your primary on the phone, ask them to make copies from your chart. if you have seen your doctor on a regular basis and weight was even discussed they might accept that. Most Dr's tell their patients to exercise, lose weight, follow such and such eating plan. Were you ever a member of Weigh****chers, Jenny Craig, anything like that where it may be documented? I had BCBS and they accepted what dr. Irgau sent them along with a letter from my endocrinologist. Just trying to think of ways to help you out, Good luck! Linda

Hi Angie, YEP I have Aetna... What I did was, I went onto Aetnas website and looked up their requirements... there is a surgical regimen you can follow. What I did was I went through weigh****chers for 3 months and had each month documented by my doctor. Then I provided them 5+ years worth of showing that I have been overweight that long. Then for the surgical regimen I advised them that I was going through that with PMRI and all that paperwork was submitted. I also had a fitness director that oversaw my exercise routine for 3 months and they wrote a letter that I was following the exercise routine for 3 months. I wrote all of this out on the letter... Their requirements and what I did to meet them and gave them aaalll the paperwork... well Actually I gave the paperwork to Dr. Wynns office and then they submitted it. Be sure to really look at the surgical preperatory regimen because that requires only 3 months worth of doucmented weight loss diet in lieu of 1 or 2 years of it. They can get cha there to delay things. Let me know if you need some help on where to check for their requirements on their website and I can guide you through it They will not approve you unless you go through the documented weight loss diet and excercise program. Best Wishes Elizabeth M

Hi Angie, You was given some great advise, I just want to add my two cents, by saying keep up on it, because the insurance companies will not give, as far as the prior diet's I tried to fight it, but finally just gave up and now I am going to my pcp for 6 months supervised diet. That put me all the way back to Nov. and my first appt. was Nov 14, 03. So for one year I have been trying to get surgery. Hang in there, just be persistant and it will pay off. Dana

Thanks everyone!