Aetna + 6 months diet history with Weigh****chers

Anyone have recent success getting approval with 6 months of Weigh****chers counting as their diet history requirement? Would like to hear your thoughts on this! Heather

I am an expert with Aetna (they probably have my photo on a wall somewhere!). Thirteen months ago (December 2006), I decided Lap RNY GB was the route for me. I began seeing a surgeon as well as my own dietician and MD. On and on until the break of dawn I saw everyone I was told to see (I met my deductible and out of pocket in 1/07). I continued on until July 07, when my surgeon told me that he would not do my surgery because of previous stomach surgery in which I'd had Prolene mesh installed to correct a umblical hernia. That's when the fat type-A in me snapped and I'd had enough! Aetna's clinical policy bulletins state that you have to have a certain BMI (exceeding 40), co-morbities (all overweight people have or will have them) like: heart disease, diabetes II, clinically obstructive sleep apnea, or medically refractory hypertension such as blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management. If you have an appropriate BMI with any co-morbidities there here is the kicker....all you must do from this point is have completed growth (be 18 or older), have attempted weight loss in the past without sucessful weight loss reduction, and complete one of the following: 1. A physcian supervised nutrition and exercise program at lease 2 years prior to surgery, where it is medically supervised and noted for 6 months. This is actually easy because all that is required is that you see a physcian and note your nutrition and exercise (which must also be supervised) for 6 months. or....the fast track (which I took)..... 2. a 3 month multi-surgical prepatory disciplinary program. Since I'd already met my out of pocket and deductible for the year, I decided to go this way. Basically, you get a physician to refer you to an exercise therapist and a nutritionist. This isn't hard, as the physician will be more than happy to help you lose weight in most cases. Then you go 1x per week to everyone, and three months later, you'll get approved if your plan covers obesity surgery. The key to taking this route is to ensure that each of the three providers code your visits with "3 month multi-disciplinary prepatory regiment" and "weight loss" as the code. If you follow this plan and your plan covers the surgery, Aetna will approve you. It took 2 weeks to approve in my case, but I also had to file an appeal to have my doctor covered as in-network when he wasn't in-network. I hope this helps and I will help you if you need help with Aetna! Best of luck....Montanapatient!