Aetna's 3 mth diet?
Okay - IM going for the appeal with Aetna's 3 mth diet. I will be re submitting the first week in July.....is 3 mths all I really need? They denied me b/c I didnt have the 6 mth thing - I have everything else....so I get notes for 3 mths - this month, next mth, and the first week in July and thats it right?
I got this from Aetna's website:
Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions:
-- Consultation with a dietician or nutritionist; and
-- Reduced-calorie diet program supervised by dietician or nutritionist; and
-- Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
-- Behavior modification program supervised by qualified professional; and
Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.)
You might want to post this on the main board and see if any Aetna policyholders can add to it. If it were me, I'd get written documentation from all of the people they require you to see above.
Also, go read Jan Ocala's profile, she has some excellent letters and information, she had Aetna at the time of her surgery. Her profile is:
http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H1082657991
Good luck!!!
~ Trish