Need help from any Aetna members

If any of you in Florida have Aetna Please help me. I need to meet the requirements in the 3 month surgery regimen but I can not get a straight answer from anyone on what will meet the supervision requirements. I have no idea who to go to to supervise as a nutritionist and to supervise the exercise program. PLEASE help me out here. I am in Central Florida.

Julie, I have Aetna and didn't have to do the 3mos regimen. Instead I had to the 6mos regimen. I live in the Tampa area so the people I used would not help you. However, I would think that either Aetna, your PCP, or your surgeon would be able to provide the information that you need. I will give you a little advanced warning, most times Aetna does not cover the nutrionist. They want you to see one, but won't pay for it. Good Luck! Karee

I live in Ocala and I have Aetna. I chose Dr. Jawad as my surgeon because of his excellent reputation in the community as well as the fact that his rate of complications was so far below the national average. But I digress..... Dr. Jawad has a nutritionist that works with his practice that you could see if you chose him as a surgeon, but it's true that Aetna didn't pay. As for the monthly physician supervised diet, you need to see your PCP on a monthly basis and have detailed office notes written. A letter from you and/or your doctor is nice (I have mine on my profile if you want to see), but it will NOT help you get approved. Aetna is very specific on this. They want NOTES. Good luck, Jan

When I get to work I will e-mail you the file I have. It lists the steps needed for the 3 month as well as the 6 months approval process. For the 3 months, you have to see your PCP, a psychiatrist, and a nutritionist once a month for 3 consecutive months. As far as exercise goes, my PCP and nutritionist are both documenting my exercise and my exercise goals they set for me. I asked the nutritionist about it yesteday and she said she has never had anyone denied for that alone, it just has to be documented somewhere. You need to be sure your PCP is documenting everyithng in your chart every month: your weight, behavioral changes you are making, your dietary changes and exercise. Aetna will ask for your chart notes every month, not just a letter from your PCP, so it is critical that he is documenting everything he is looking for. I am going to the nutritionist that works with my surgeon. She does not accept any insurance, so I am paying out of pocket. $200 for the first visit, $75 for the second and $75 for the third. I could go in network and only have to pay my copay for each visit, but this lady knows exactly what my surgeon wants as far as pre-op and post-op diet and she works with insurance approvals every day, so she knows exactly what Aetna is looking for. I trust her more as far as getting me approved than I would anyone else.

Hi, I have AETNA PPO and I was recently approved for the surgery and I had documented a diet and exercise program with an MD that is a genreal practicioner and runs a weight loss program in his office. This of course was all out of pocket but in the end it was exactly what I needed. As far as the price it was not cheap but not as expensive as a nutritionist. I paid $125 the first visit and then I had bi-weekly visits at $60. You might want to look into an MD that has a weight loss program within his office. Gesell

I have Aetna and since I have several co-morbidities I did not need the Diet records. Please understand because of other problems I had been in the hospital 3-4 times a year. They took that as my medical records. I had a great case worker. If you don't have a case worker yet - ask for one it will make a big difference.