I have been trying to get...

I have been trying to get approval for surgery at Barix center in Groveport, OH. I had a consultation, and was assured they would do anything to help. Well.... after calls back and forth to the center, I feel I am going to be denied by my insurance (Honda of America's Aetna) for the fact that I do not have doctor supervised weight loss program for the immediate past 2 years! When I went to my consultation, I was assured that Honda was quite cooperative.(they are NOT) My family doctor does not do "weight loss programs"... he tells us to... "diet & exercise". So I went to Jenny Craig... weigh****chers and did other diet programs... (in the past 30 years I have lost and gained back so much weight doing theese programs!!!!) obviously... this doesn't qualify as "weight loss programs" to the insurance company. My family doctor does not do any of the "drug" diets that require office visits.... This must be what Aetna was looking for... So, I am wondering if there is anyone else that has had this problem with Aetne / Honda... and if you came to a solution. My husband will NOT finance this surgery.... so If I do not get insurance help, I am doomed.

Without seeing your policy - I can't be positively sure if what I say is true for you. Aetna's requirements are on their website http://www.aetna.com/cpb/data/CPBA0157.html They do not require a 2 year diet - they recommend a 6 month dr. supervised diet that has happened within the past 2 years. They will accept WW, Jenny Craig, etc. AS LONG AS your doc. has put it in your medical records that you are participating in one of those plans and you can send them the proof of attendance such as your weigh in card from WW (that's what I used and I have Aetna). As for you doc not doing weight loss plans - all he needs to note in your chart is that he put you on a reduced calorie diet and that he has recommended exercise (even if he just puts down that he advised you to walk 20 minutes a day). Then, just make an appointment monthly to get weighed and discuss your weight with him for a couple of minutes. As long as he documents everything in your record, that's what Aetna needs to see. Also, you can make an appointment with a nutritionist or dietician on your own and take a copy of their information to your PCP and have him put it in your records that you seen the dietician. If your family doctor doesn't want to help you obtain this surgery, I'd say it's time to get copies of your records and find a new doctor. I don't know where you live, but I see a dr. in Lithopolis (southeast of Columbus, between Columbus and Lancaster) and he is great. He has several patients who have had WLS. His name is Dr. Eric Legg just in case you or somebody else reading this is interested. Good Luck.

Thanks for your reply. The stipulations I am talking about in my first post is a requirement by Honda, above and beyond what Aetna wants. I have been sent MANY email responses - several from Honda families!!! Just this morning I chatted at length with my insurance case worker at Barix, and she went over each little tidbit that Honda wants. My husband and I may decide to go ahead and pay out of pocket for the surgery... which will mean another BIG loan to pay off. But, in the long run, MY HEALTH is worth it. and... we WILL keep fighting Honda, even if it does not help my case, maybe we can get them to change, to help someone else down the road.

Deb, Let me say, I FULLY understand. My husband is an employee of Honda and I also went through the promise that Barix would do anything to help. Since February until last week, I begged them to submit, I've gone through the surgical clearances the doctor requested and got the door slammed in my face. I even MENTIONED the requirement to the doctor who told me it would probably only take a letter from my PCP to get approval but I can't get it submitted because THEY WON'T submit it! I'm going to e-mail you privately and tell you what I've learned and what I'm doing now. And to anyone else who thinks just meeting Aetna's requirements will get approval-they won't if you have your policy with Honda. They require TWO years of what Aetna says in their bulletin on the web. Beth

Just curious, is Honda's insurance self-funded and they have Aetna administering it? I have United Healthcare through my husband's insurance, and it's essentially self-funded - UHC just administers. Fortunately it seems like the requirements aren't as rigid as what I've heard about from Aenta. -Anne

Yes Anne, that is exactly correct. Honda places these requirements ON TOP of what Aetna already states on their website. Glad yours isn't as rigid. Its not easy to meet the Honda requirements as many people have found out and I'm sure to the delight of Honda. I'm amazed and quite frankly disgusted at a company like Honda that says they are so "pro family" and "pro active" to have this kind of stipulation and make it so hard for those who truly need the help. Beth

I feel for you. TWO years of supervised diets is it? I haven't seen my approval letter yet, so until that is in my hands, I'm not going to sit back and relax. For all I know, I could get some ridiculous additional conditions added on, but as far as I know from UHC and HR just need the MO DX. And of course the laundry list of referrals, letters, tests etc showing that I truly need the surgery. I hope you find a way to work around this, perhaps future legislation might make it harder for Honda to keep you from the surgery. -Anne

My husband has put in SEVERAL calls to the Insurance liason to Aetns for Honda... as of today, no calls have been returned. He has also spoken to several peope in Administration .... they have heard "my story" SOOOO many times in the past few months... I think big letter writing campaign to HONDA is in order. I know that several years a go, Honda put a stop to the insurance paying for Lasix (sp?) eye surgery.... but THIS IS NOT THE SAME!!! (GRRR @ Honda!) WLS is to better my overall health!!! Why can't they see that WLS will SAVE them $$$ down the road!!