UGH AETNA

So they called my surgeons office today after denying me again. NOW I have to do an additional 3 mth program so that I have the total 6 mth thing. THEY NEVER STATE THAT YOU HAVE TO DO THE 3 MTH REGIMEN WITH YOUR SURGEON...BUT YOU DO. YOU HAVE TO SEE THE SURGEON, PSYCH., AND NUTRITIONLIST, FOR THE 3 MTHS....I was seeing my PCP. Anyways UGH so here we go for an additonal 3 mths and Im also going to have a "phone consultation" with my Uncles Ex Wife who is a nutritionlist - dated for the full 6 mths. The way diet, nutrition, and Ill make an exercise log so that its ALL listed and documented. They mentioned that the noted I had were fine but they want 6 mths of them and they will aprove me. Thats what was told to my surgeons office. So they are scheduling like 2 weeks out right now for surgeries so if all stays the same Im looking at a date of about the 24th of October!! But lets pray all works out and they dont screw me over again.

Actually, Aetna's guidelines are very clear and are stated in writing on their website. I'm sorry you misunderstood, but one thing you learned for sure is that there are NO shortcuts. If they say a 3-month multi-disciplinary program OR a 6-month program with your PCP, that's exactly what they mean. You'll get there, just do what they ask!! Good luck and hang in there! Jan -107 lbs.

Clear? NOT EXACTLY! Granted YES the Multidiciplinary regimen is outlined - clearly - I CAN RECITE it - but NO WHERE in there does it state that that 3mth program must be done with a surgeon, psychiatrist, and a nutritionalist...granted it says behavior modification and A consultation with a dietition/nutritionalist - but NO WHERE does it state that THAT must be completed SOLEY by the 3 of those people. Because if it had I never would have thought I could get my PCP/Nutritonalist to document my 3 mth journey and get away with it! I mean LIFE GOES ON and Im dealing with it now - Im fine with an additional 3 mths with my PCP. But no Aetna is not as clear as you're trying to tell me they are! I dont appreciate the attitude in which your reply was given!

Ok now I feel like an a$$ because although I took offense right away to the top section of your post - basially telling me to read more carefully b/c it was there and i still very much so disagree - I re read it and see that you ARE trying to be nice and supportive in saying good luck and hang in there - and for that I apologize if I came off harsh as well in saying I didnt apprecaite the attitutde you gave me. Im sorry

You're sweet, Gina! The written word on message boards can come across in all sorts of ways. I was really trying to be supportive! After all, I've been in your shoes, both with being impatient to get the surgery going AND having to deal with a pain in the neck insurance company! I didn't mean to be judgemental at all, and you WILL get there!! Hang in!!! I did want to post the site on Aetna's website that outlines their criteria for you. I assume you've seen it, but just in case, it's: http://www.aetna.com/cpb/data/CPBA0157.html And, although it does go into detail, the part I was referring to says "Member must meet EITHER criterion a (physician-supervised nutrition and exercise program) OR criterion b (multidisciplinary surgical preparatory regimen)." (Note: I made the words "either" and "or" capitalized for emphasis.) Then in the details that follow, Aetna says that option A needs to be for 6 months and option B is for 3 months. Say, Gina, if you want to, please take a look at my profile and if you think the letter I wrote to Aetna will help you to show them that you have followed their criteria, please feel free to borrow it and change it to suit your personal cir****tances! I'm on YOUR side, girlfriend!! Feel free to email me and if there's anything I can do to help, or just a listening ear, let me know!! You WILL get there!!! Jan