Aetna multidisciplinary diet question....(x-post)

If you had to do a multi-disciplinary diet for Aetna can you tell me a bit about it?  How often did you meet with your docs? Did you have to meet with your PCP too? Did you have to work with a psychiatrist? Did you go through a program with your surgeons office or an independent nutritionist? How was it documented? My surgeon works with a great plan but they require you meet with them once a week and they are a good hour drive each way. I can and will do it but want to see if there are other options that are feasible and that will get approval.  Doing 3 months and still getting denied scares me.

Hi, I'm in the same situation as you. I start my 3 month for Aetna Wednesday. Johns Hopkins weight management center is handling it. It is 45 min-1 hr away from me depending on traffic. I live in DC. It sucks that they want me to come 1x a week  too. Where are you going for yours?

Mine would be at Johns Hopkins too! I work in DC live in Maryland so we are looking at about the same drive.  Good luck! We might bump in to each other there  :-)

I am currently doing the 3 month for Aetna.  My surgeon is 2 hours away and I only go once a month.  The first visit was all day (blood tests, ekg, gi, chest x ray, pelvic ultrasoune, and resperatory tests)  I also met with the surgeon, dietician and exercise therapist.  Second visit was the surgeon, dietician and exercise therapist.  I haven't went to the third visit yet.  I read somewhere on here that after the 3rd visit you don't have to wait the entire month to submit to Aetna you can do it right away.  The program director for the surgeon told me that they have had no problem getting approval from Aetna and I also spoke to a patient who was approved without a problem.  I told the program director that I lived 2 hours away and thats when he said I would only have to come once a month.  Hope this helps.

Oh and I also had to have a psychiatric evaluation(required by surgeon, not by Aetna)  The program wanted to charge me $200 to see their psych.  I asked if it was ok if I went to my own in network and they said it was fine, she faxed it to them and I only paid $15 co pay.

That is good to know. Let me ask you another question. For the dietician, Aetna told me I have a $500/yr allowance if it's related to obesity. I checked with Johns Hopkins and got the names of the two they allow. Aetna told me that they did not see them in network and also did not see any nutrtionist/dieticians listed because they were not actual practioners. Did you run into that or just pay for it out of pocket?

The live lite program had everybody there that I had to see.  I don't know if they just billed Aetna as an office visit or what.  I was also told (in all my calls to Aetna) that for a surgeon out of network they pay 50%.  I would call and ask  what  % they would pay for a dietician out of network.  I am lucky I found a program that does all the requirements there.  Good luck. 

I just found out today that I am required to do this because I have the Aetna EPO so I am just now learning as well.

My surgeons office gave me the option to have my PCP do this or the surgeon offers this as well.  I chose the surgeons office because my PCP is not really pro wls.  She thinks everyone should be able to lose weight on their own (glad my insurance did not require a PCP referral to a surgeon).

My surgeons office went ahead and scheduled my 1st appointment in May to get me started and the 3 after that for June, July & August; so I will only see them once a month.  Funny thing was that none of this was mentioned at my initial appointment with the surgeon last week, maybe because the insurance girl was not there???

Anyway, good luck!  I am still trying to figure out what happens if you don't lose enough weight (if any at all) or if you lose too much.

i had the same problem last year with a PCP who was not really pro-WLS. fotunately he has come around. I have Aetna also and I am doing the 3 month multidisciplinary regimen too. My 3 months will also be done in August- on the 14th. As far as the clinial policy bulletin goes, there are no requirements for wight loss during this time.

I live in Georgia and there was a multi-discplinary program with a nutritionist and exercise physiologist at the hospital where I just had my surgery. It was an hour drive and I did go weekly. I also did the 6 month diet at the same time with my PCP just to make sure Aetna didn't deny me. I just had my PCP comment each month on what I told her I did at the multidisciplinary program and just had everything well documented. I did all of the other requirements with different doctors. I did pay for my nutritionist consult out of pocket. With all that being said, I was approved the same day Aetna actually looked at my file. Aetna was quick and wonderful. I am so pleased. I had my surgery Monday and it was worth all of the hoops I had to jump through. Going in to surgery I was healthier and more informed BECAUSE of everything I had to do. Good luck.