Aetna EPO anyone?

I'm trying to figure out if they'll accept Weigh****chers as the 6 month supervised weight loss. I don't want to bother with it (again...) if not but I want to go ahead and get started if they will. I can't get anyone at Aetna to answer my question!!! They say I'll have to get my surgeon's office to find out for me. The problem with that is that I haven't decided on a surgeon yet and whether or not WW is acceptable would be a factor in helping me decide. Insurance companies are sooooo annoying!

Hey Billie!! Well first I'd like to say good luck in your journey. No matter what you have to do to get there, it will be soooo worth it. I had Aetna PPO and I had to either do a 3 month surpervised diet with a surgeons office or a six month one with my PCP. I chose the 3 months and my surgeons office had everything there in their office...the phsycologist, nutritionist and exercise specialist. They were awesome! And the 3 months went by so fast. Once I did everything Aetna asked, they approved me within 48 hours! So, I know EVERY situation is different, I just wanted to give you an idea of what I went through! It was smooth sailing as long as I did what they asked! Good luck! And let us know how it goes! Jodie

Ms. Billie, For aetna to cover WLS: Member has completed growth (18 years of age or documentation of completion of bone growth); and Member has attempted weight loss in the past without successful long-term weight reduction; and Member must meet either criterion a (physician-supervised nutrition and exercise program) or criterion b (multidisciplinary surgical preparatory regimen): Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record. This physician-supervised nutrition and exercise program must meet all of the following criteria: Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and Nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least three consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of six months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.); and Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records; or Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions: Consultation with a dietician or nutritionist; and Reduced-calorie diet program supervised by dietician or nutritionist; and Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and Behavior modification program supervised by qualified professional; and Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.)