Aetna - and my story, just in case anyone else has Aetna

As of now, all my tests are done except for the endoscopy.  Two days ago I FINALLY met with Dr. Pohl, and all my reports were there.  We are just trying to get the pre approval from Aetna now.  This is where the whole thing came crashing in.  I was hoping to have my surgery in June sometime.  But one of the requirements for approval is that I spend 3 months gathering documented information on an exercise regemin, 3 months dieting with documentation from a nutritionist, and then 3 months of behavoir management. I think I was pissed about this mostly because I had printed down the requirements and sent them to my PCP in March with a letter stating that if the infomation required for this was not in my health records already, then please let me know so I can get on this right away and not be sitting here, like I am now, two months down the road and just beginning this 3 month thing.  But he seemed to think all was there, or just didn't give a damn.  Also, I guess I should have pressed harder.  But I didn't, and I take responsibility for that. When I entered Dr. Pohl's office on Thurs, I was SO excited, and I left feeling very depressed.  So I went directly to my gym and met with a trainer.  I now have a personal trainer for the next 3 months who will document my weekly visits with him, and will supply all the reports of our times together along with a letter to Dr. Pohl to add to my insurance package.  I actually worked out with him for the first time one day after I found out I needed to do this, so as of 4/25, I am beginning to fulfill the 3 month requirements. (BTW, Aetna is not paying for my trainer, even tho they require me to see one.) After coming home from the gym, I contacted a nutritionist, and I also began meeting with her yesterday as well.  I will see her again in 2 wks, but I think this is going to work out well.  She will also be able to document our meetings, and provide proof of behavior modification for the insurance co.  She IS covered  by Aetna. I did go thru some real crap with Aetna on the phone on Fri, trying to get someone to answer my questions about what specifically was required to meet the items listed on their policy bulletin #0157, and it was hell trying to get someone to finally tell me what I needed to know.  The CSRs there are idiots.  But they did connect me with someone in Pre-Approval, and that woman was SUPER nice and incredibly helpful.  So any further questions I may have, I will definitely refer them to that department.  Aetna requires AT LEAST 3 months of documentation that I participate in a PRE-SURGICAL diet and exercise regimin.  If you have Aetna, get started on it right away!! In the meantime, I am actually feeling much better since I met with the trainer and dietician.  I think I will be much better prepared when I finally have the surgery (hoping now for Aug.) and I think all this will help me be sure I succeed.  I am actually happy I have had these cards dealt to me now.  Wasn't feeling that way a few days ago...but this is not a race, it is a journey and I am comfortable with that today.  I hope to get to that loser's bench at some point!!!  I appreciate all the support I have been given by you all.

HEY CARA,  SORRY TO HERE ABOUT THE INS PROBLEMS. BUT EVERYTHING WILL WORK OUT OKAY. I HAD THE SIMILAR PROBLEM BUT FOUND OUT RIGHT AT THE BEGINNING SO I HAD TO DO A 6 MONTH "I CAN CHANGE PROGRAM" WITH MY INS (GOVT) AND THAT IS WHYIT TOOK ME A YEAR TO GET WHERE I AM NOW. BUT IT WILL GO BY FAST. YOU JUST HAVE TO ACCEPT THE OBSTACLES THAT ARE DEALT TO YOU. HAVE A GREAT DAY. DEBBIE

Thanks Debbie!  Yes, I have accepted the situation, and am doing fine with it.  I honestly think this will work out to my advantage as I will learn so much over the next 3 monthst to help me be better prepared for the changes after surgery. I just had to take ONE day (which I think is a pretty short time) to greive the fact that the universe had a different time frame for me tjhan I had for myself.  I also wanted to let people know, who might not have considered this kind of thing , to check on this stuff as early in the game as possible.   I started my whole journey , beginning with the seminar, on Valentine's Day.  So in reality,taking until August to get my ducks in a row is not a long time to wait for something as life changing as WLS.

Hi Buddy! I commend you for not giving up! I love your positive self-talk! You know what? God has three answers....Yes....No....and Wait. You've got all of it covered! Thank you for putting the word out about Aetna! You're always thinking of others! You're amazing! I just wanna dip you in my coffee (Madagascar)!!! Jules

hahaha!!  This is so like me, Jules.  I am now on a mission to learn as much as I can and get in the best possible shape for surgery and beyond.  I guess I am really better because I don't feel like I am standing still and waiting...I am DOING while I'm waiting, and for me, that makes all the difference in the world.  If I have to drive 50 miles out of the way to be moving instead of sitting in traffic, I'm happy.  This is just more of the same.

Cara- I know you joined the gym a while back, I am sure you probably sign in with one of those electronic scan cards.  They keep the info of all you visits in the computer.  Will this be enough??  Also- what do they mean by "behavior modification"?  What about getting sign in sheets for the support groups you have attended? Hopefully these may be acceptable??

Hi Beth, yes I joined the gym in Oct.  Back in Feb, I asked if they would run a report for me to show the days I came in there, and they said they could only give me the last 3 days.  I thought that was bull ( I was in Informations Systems for 25 yrs...I know that data is kept for yrs and reports can be run with no issues whatsoever), so I emailed their home office and asked. There I was told they would look into it and get back with me.  They never did, but in the meantime, they were getting very lax at the gym with signing you in.  We have a key tag, but we don't scan it or anything.  The people at the counter have to type it in, and they hardly ever do it...we just show it..so that would not have given me the proof I needed.  Good idea tho.  The behavior modification is just to show that I have learned some things about eating and exercising, and that I am changing my behavior by doing those things.  I was told by Aetna that my nutritionist can fullfil that requirement by the report she sends them, and luckily, I am seeing Heather Gaglione...(know her?)..and she has dealt with Aetna many times in the past and knows what they require.  I can also get the moderator of the support group to write a letter, and she agreed to do that for me when I spoke with her Thurs nite.  All great ideas, Beth...and I am working on them.  As I said in my reply to Julie, I feel better now that I am actually working towards all of this...on a mission.  I admit, the waiting without having something to do in the meantime would be killing me...but right now I really and truly feel good about the process.  I know in the end it will have been worth it,.  Thanks bunches for your caring reply.

It will be so worth it when you finally get though this!  It sucks as you have been doing these things!!  You have such a great attitude and it will so help you through all these struggles! good luck

Thanks!!! 

Hey Cara,

I admire your perservarance.    Everything that you are going through now will definetly help someone in the future.

Robin