Help understanding Aetna Denial language

Aetna has a good website.  Register as a member and then poke around to find the criteria for your plan.  MY Aetna plan is the choice of 3 month or 6 month, but EVERY surgeon's office I called said I needed 6 month. When I picked a surgeon, I printed out the policy bulletin (see the link in the previous reply) and took it in to the surgeon's insurance girl.  Sorry, don't know what MAMSI is.  Aetna, like all other insurnace companies, has a bunch of different policies.  You could call member services and get them to clarify the specific language of your policy, and get some help with Aetna's site to drill down to find the policy bulletin for your plan Good luck! Wendy

Same here, I have Aetna and even though the bulletin says 3 or 6 months, my surgeons office said that they really do want you to do it for 6 months.  The sooner you start the better.  I'm in my 5th month and it DOES NOT go by fast! 

Great stuff... I redid my sleep study to see if it will qualify as a co-morbidity now. The surgeon's office thought I had met the six month requirement because I am currently taking Phentermine/Prozac which requires monitoring, I did 3 months of "BootCamp" which my doctor approved and noted my progress. He also used the fact that I only lost 8 lbs as his reason for recommending the surgery. I also saw two different surgeons before I submitted. I did the psych and nutritional evaluation. My doctor sent all my obesity related progress notes, full weight, medication, and blood work result history. I did a complete diet history. The biggest issue is that with all of the running classes, diet pills and diets my wieght has bounced between 200 and 228 in the last 5 years. My BMI was only ever technically 40 in 2004 when I got up to 225 and now that I am 227. I lost a pound between this and last week. So to answer the questions... no my BMI has not exceeded 40, but the surgery is recommended because I have attempted so many things and because I border on excessive with exercise. I run 30 minutes everyday to reduce depression and the need for medication. The psych evaluation and test indicated that as a part of my personality.Unfortunately, all of my attempts to lose weight are working against me.