I want to do this right

This is my 2nd go around for getting WLS...my last employer screwed me after I completed everything and they "oops" and told me I was covered when I wasnt. Anyways, Ive now been with my current employer for a year and am starting over with a new PCP. Clean slate... currently I have BCBS but will have Aetna Choice 2 as of January 1st.  They do cover the surgery but they have rules.....states the 6 months of PCP and a Nutritionist, what about excercise and such...my last PCP would only have me come in to be weighed monthly- I never even saw him.....My first appt with my new PCP is Oct 31st, hoping to make this the beginning of the finale to the surgery any tips, guidelines or help is greatly appreciated....aetna also mentions the 3 month program on their webiste but isnt listed in my new coverage book.....hmmmm
  Bariatric Surgery
Coverage for bariatric surgery requires you to satisfy
the following eligibility criteria in order to seek
approval for the bariatric surgery benefit. To review
these eligibility requirements, precertify, find a designated
Institute of Excellence (IOE) or get other information
regarding your bariatric surgery benefit,
please call: 1-800-.
You must meet these initial eligibility requirements.
Other rules may apply:
• Meet the following Obesity Guidelines:*
—BMI of equal to or greater than 40, irrespective
of co-morbidities as defined by National Institute
of Health (NIH), or
—BMI of equal to or greater than 35, with at least
one significant co-morbid condition as defined
by National Institute of Health (NIH). AND
• Complete a six-month physician supervised
weight loss program that includes nutritionist/
dietician involvement prior to surgery; AND
• Complete a pre-surgery psychological evaluation;
AND
• Have the surgery performed at a facility that has
been designated a Bariatric Surgery Institute of
Excellence as defined by Aetna AND
• Seek prior approval before obtaining any Bariatric
Services through pre-certification/prior notification
to activate bariatric surgery benefit.
If you live more than 100 miles from a designated
Institute of Excellence, you may be eligible for Travel
and Lodging reimbursement of up to $50 per night
per person (up to $100 total). There is a $10,000
Travel & Lodging maximum per procedure. All Travel
and Lodging reimbursement must be pre-approved.
Exclusions Related to Bariatric Surgery
• Cosmetic Surgery to correct such skin conditions
as excess skin after successful weight loss,
unless medically necessary
• Breast Reduction and Abdominoplasty, unless
medically necessary
• Revisions, unless medically necessary
• Any member under the age of 18

---

New MapQuest Local shows what's happening at your destination. Dining, Movies, Events, News & more. Try it out!

 Sounds like you have it easier with Aetna. If they only require 3 month supervised diet then that's 3 months earlier for referral to a WL surgeon. Make sure your new PCP takes Aetna that way you don't have to switch PCP's during this process. It doesn't matter if you do switch but it'll be easier for you because you won't have to get records from everywhere. When you do the supervised diet, make sure,  you go once a month every month for 3 months in a row. If you don't see the PCP then ask to see a nurse or someone you can talk to about what you are doing on your "diet". Have them document everything, your weight, what you're eating, how much you exercise, anything and everything you can think of. Oh btw make sure that you complain about all that ails you. Do you snore? If so ask for a sleep apnea test.  Ask your PCP to refer you to a nutritionist and start your 3 months with them as well. If you can afford it pay for a psych eval out of your own pocket that way you can have your PCP submit that with your pre-certification. Good luck. Hopefully someone with Aetna will come along and gjive you more/ better info.

Thanks, I already have a psych eval from my first baraitric surgeon, im hoping ( fingers crossed) that aetna will accept it...one of the many things I will need to ask them, In your opinion should I wait until after January 1st to call the number since thats when the insurance starts or should I call now since Im already enrolled to ask for the info????

 If you know which Aetna plan you'll have you can always go to their website and download it. Your insurance should except your pysch eval as long as it's not over a year old. You could always call, what could it hurt. Best of luck