Has anyone had to deal with Aetna Open Choice POS

I just got my appointment with Dr. Stellato and I am not sure what to expect from Aetna. If I had known that I was going to chose surgery I would have documented all of my weight loss attempts, but I haven't. Is this goin to be a huge problem?

Susan, We have Aetna PPO. I've not yet submitted because I can't GET my surgeon's insurance department to do it. The main reason is because I do not have the 2 year requirement of documented dieting attempt whi*****ludes the nutritionist and exercise regime. Well, I've got two years of consecutive dieting attempts (and more) but they don't include the other two so, the surgeon's office says Aetna will deny. Fair enough but last week, I called my husband's employer benefit department as well as Aetna. I don't have two years to sit back and document as my health will be so bad in two year's time, the surgeon said he would not consider me a candidate in two years. I told this to the benefits department as well as the pre approval folks at Aetna and they told me (as well as my husband who I didn't realize was doing the same thing I was doing) that I should submit, get denied and then go through the approval process as that's when they review the "whole" file-doctor's letters included, and I have those. I'll have to show that waiting two years would be more detrimental than waiting two years and documenting the way they want to see it. Now, if you don't have any exculsions like my husband's employer, Aetna has a three month regime which isn't too bad. They changed that in March, I believe. Go to their website and check it out. If I could get away with doing anything more than what I've already done, I'd do the three month regime! Its far more reasonable than the 2 year requirement they say I need to have! Good luck! Beth

Aetna requires a 6 month, dr. supervised diet within the past 2 years, a nutritionist consultation and a "prescribed" exercise regimen. This must all be documented in your PCP's records and submitted to insurance. If you do not already have this, get started now. Aetna will accept Weigh****chers if you have your weigh-in cards and your PCP has documented that you attended. Here's a link to Aetna's requirements in case you haven't seen them: http://www.aetna.com/cpb/data/CPBA0157.html They do seem to be sticklers on their policy. If you don't meet the requirements (or they don't have the documentation to prove it), they will deny. Good Luck