Has anyone had this with Aetna??

My surgeon sent in my packet to insurance last week... and Now i have received a letter saying


"The following information is needed: A letter of Medical Necessity, 5 year weight history and office notes (within the last two years) from a physician other than surgeon documenting 6 moths of physician supervised nutrition and exercise program in cooperation with a nutritionist OR office notes documenting completion of a 3 month multidisciplinary surgical preparatory program."


Which We sent them!!!  Any ideas on what they want or what they might need? I'm going to call in a little while just wanted to see if anyone else had this =) Thanks!

I'm having problems with Aetna as well.    I had all my paperwork complete - along with 5 years of office notes from the PCP sent along with all the other documentation from my surgeon two weeks ago -- today I called to check up and all I get from Aetna was "we never received it"  Called my surgeon's office and had them re-fax the information to the # Aetna provided me. 

Are you having bypass or lapband?

Adrienne G. 

Aetna really is a pain in the butt it seems like. I had a pre-op class yesterday and everyone there with Aetna has been having problems. I called my Doctors office yesterday and the girl in charge of insurance said not to worry about the letter that everyone receives it, but everyone told me she really isn't as on top of things as she seems and they didn't get that letter... and to call insurance to make sure everything was fine.  I was told that Aetna's fax was broken and that she had to mail everything to them, so maybe there really was a problem with their fax and they didn't receive it. But then again at the class everyone there were also told that Aetna's fax was broken and a woman called and figured out the girl just had the wrong fax number lol. So who knows!!! I am getting lap-band how about yourself? <3 thanks!

Ughh! Aetna  .. I swear my BP goes up just seeing the name! Good Luck!

=) haha. I guess you have had problems with them as well?

I can tell you it's one of only a few things.... 1. Aetna did not receive the whole (or any) of the fax 2. too much info was sent and Aetna does nto want to read it all.....I have much better luck if I only send one office note with the weight on it for the 5 year thing. I circle the weight and write on the top of the page  "patient weight or 2005" etc.   If you fax them 5 years of office notes, pap smears, lab results.....they will NOT read it searching for the info, they will ask you to send it because they cannot find it and are not willing to search for it.  3. your info was not sent to the correct place/not sent at all Ask your office contact for the fax comfirmation....she should have it......and be able to tell you XXX pages were sent to 1-800-xxx-xxxx at 359 pm on xx/xx/xx... With Aetna you are( the office asking for surgery) supposed to call and open the case first and get a reference number that you are supposed to include on the faxes. That letter might have been generated when your case was opened but before they received the info from your doc's office. I've never had a problem with Aetna's fax, but I have with Cigna and Anthem BCBS. Just ladt week it took me over 45 minutes to get to a human with Anthem to tell them their fax was not working and the ***** on the line argued with me that it was working. I was losing my cool and told her how the hell would she know since she was a service rep and the um/pre-d dept is not anywhere near her! I had to ask her to put a supervisor on 3 different times because she had no clue! Anyway, their fax WAS down. I had to wait another day to fax my stuff! Call Aetna, they will have a record of what was received, they can tell you the number of pages. It should be at least 20, dependant on the amount of records they sent.  Good luck! Bonnie

Wow thank you for you help. I bet that number 2 is right. They don't want to read through all the information lol. I will do like you said and circle the weight when I send it to them. I have issues with the lady at my surgeons office. She told me not to even worry about the letter, but I don't think i should just trust her on that lol. Especially since I have spoken with insurance now and they are still requesting all of the same information. I am going to handle sending everything on my own this time because, like you said, she didn't even have the correct fax number and she had to mail it in to aetna. Then I found out from talking to many people at aetna that she didn't have the correct number and they have given it to her but she is still convinced that the fax just isn't working! Ugh!  Oh well, just hopefully my doctor will get my 5 year history to me soon!  Thanks again!

Be careful and only give them what they ask for.  You do not need to provide each weight for each year, only one per year. So pick the highest weight for the year and send only that. Do not send additional records, the insurance company can and will use them against you. I've seen people denied because for part of the year their weight was low because they were going to LA weight loss! If only the high weight for the year had been sent, she never would have gotten denied. Yes, she won the appeal, but lost 3 months doing it! The same goes for everything--only give them what they ask for--- Good luck! Bonnie

So they do only want 1 record for each of the years showing your weight for the 5 years? I don't need to send them all of the office files for those 5 years? I guess that makes sense,  since It said they wanted 5 years in weight history and 2 years of office notes. That is a great idea as I am one of those people who one year did jenny craig and lost a ton of weight  then did beverly hills weight loss.. But I always gain it back! I didn't even see my packet that they sent. I was told it would be between 100 and 150 pages because of the 3 month nutrition and exercise program. I will be sure to only give them what they need, and you said to be sure to circle the weight on them right? I just hope they don't go back in my 2 year office notes and see that i had lost a lot of weight at one point.. and yet still put it all back on! Thank you SOO much for all your help!