Aetna Requirements

Hi all, I've finished all the required appointments except the surgeon consultation, but have found that Aetna requires six months of working with a dietician and doctor before they will approve surgery. Has anyone ever gotten around this requirement? I have a long history, like most of us, of losing and regaining. I guess this isn't enough for them. I'd like to hear of anyone else's experience with Aetna. Thanks. Pam

Pam, I don't have Aetna but I did have the same requirments with my insurance company CIGNA. They were very strict about having the 6 months of a doctor monitored weight management program within a year of applying for the surgery. I would get started right now and hope that Aetna will see how neccessary this surgery is for you to forgo that. If you are doing or have done a support group (i.e. weigh****chers, jenny craig ect...) find out if that counts from your insurance. Get their SPECIFIC requirments IN WRITING!! I completled my 6 months in Nov. and have been give the run around for 3 months of denying me. I just got word today that they did approve. My best advice to you is to NOT GIVE UP. It usually takes you forcing their hand. If they do deny you based on the 6 months, go into a appeal. You can be working on your weight management program while you are in appeal. Good Luck. I have been through this time and again (3 denials from CIGNA) before my approval. If you need to talk my email is [email protected]. Feel free, ANYTIME. Sam

HI Pam, I have Aetna insurance and had my surgery Dec. 22,2003. I kept my fingers crossed during the approval process and was approved the first time out. I got a copy of their requirements and sent in everything they asked for. I think they relaxed them a bit by saying that your surgeon can now be counted as part of the process. I sent them proof of Weigh****chers, medical records from my PCP that showed he had noted my weight loss attempts and weights (over the last two years), and he wrote a letter. My surgeon has a full program that includes a dietician and he also showed weigh-ins for three appointments in three consecutive months. I will gladly help you with this in any way that I can. Feel free to e-mail me at [email protected] Sandy