Aetna 3 month program
My first PCP appointment was 10-31 and dietician & fitness expert were a week or so later.
My understanding is that you'll need at least 1 appt with PCP and dietician in each of 3 consecutive calendar months. My dietician sent copies of all her office notes to my PCP, and I also gave my PCP a plan outline from the fitness expert. That way only my PCP had to send records to the surgeon's office. I only had one appointment with fitness expert to plan the exercise portion of the regimen, but dietician noted progress every time I saw her.
I had to push a little with the PCP's staff to get the appointments so close together, they were very resistant. Don't let doctor's staff tell you what you need because they don't work for Aetna. I had to invent / take charge of my own regimen and it worked out fine. Aetna didn't seem to care how many weeks are/were between the appointments as long as the consecutive calendar months are/were covered.
I submitted paperwork via PCP to surgeon in early February and was approved by Aetna on first attempt. (in the end I had 4 appts with PCP, 3 with dietician, and 1 with fitness expert). I appt each in NOV, DEC, and JAN. My psych eval was done in my surgeon's office before the 3 months regimen even started and was apparently sufficient.
Hope this info helps.
My understanding is that you'll need at least 1 appt with PCP and dietician in each of 3 consecutive calendar months. My dietician sent copies of all her office notes to my PCP, and I also gave my PCP a plan outline from the fitness expert. That way only my PCP had to send records to the surgeon's office. I only had one appointment with fitness expert to plan the exercise portion of the regimen, but dietician noted progress every time I saw her.
I had to push a little with the PCP's staff to get the appointments so close together, they were very resistant. Don't let doctor's staff tell you what you need because they don't work for Aetna. I had to invent / take charge of my own regimen and it worked out fine. Aetna didn't seem to care how many weeks are/were between the appointments as long as the consecutive calendar months are/were covered.
I submitted paperwork via PCP to surgeon in early February and was approved by Aetna on first attempt. (in the end I had 4 appts with PCP, 3 with dietician, and 1 with fitness expert). I appt each in NOV, DEC, and JAN. My psych eval was done in my surgeon's office before the 3 months regimen even started and was apparently sufficient.
Hope this info helps.
(deactivated member)
on 2/27/09 12:05 am - Woodbridge, VA
on 2/27/09 12:05 am - Woodbridge, VA
William is right--it doesn't actually have to be 90 days, even though Aetna will tell you it does. Just make sure you get your appointments in within 3 consecutive months.
I agree, with what everyone said here. I was approved on the 3 month multidisciplinary program also. I had appointments with my PCP 9/29, 10,27, 11/25, 12/29 and 1/12. I had appt with my dieticien 10/13, 11/16, 12/10 and 01/12. I had an appt with the exercise specialist on 10/13 also.
My PCP documented everything - that I was working with a dietician and exercise specialist and working on behavior modificaion. each the PCP and the dietician wrot notes each time and i had the dieticien and the ex. spec forward their notes so they were included in my pcp notes.
My pcp wrote a letter stating i had started the 3 month multidisciplinary program and then another letter stating the surgery was a medical necessity and that I had completed the program.
I sent the stull in on a Thursday and was approved the follwoing Tuesday.
The only thing is (and the other poster addressed this) is that I was told by Aetna it had to be 90 days.....no less. that is why I did the 1/12 appointment because he had told me if I would try and submit after my 12/29 appointment (which I was thinking Oct/Nov/Dec since I started 9/29) would be my three months that it would get denied...that it had to be 90 days from the time I saw the dietician.....so I went 90 days out from 10/13. I had also heard that from other people on this website who worked in insurance billing so i didn't want to chance it. Not sure it it's true or not??
Good luck to you! My surgery is one week from Monday!! Getting approved is a great feeling!
My PCP documented everything - that I was working with a dietician and exercise specialist and working on behavior modificaion. each the PCP and the dietician wrot notes each time and i had the dieticien and the ex. spec forward their notes so they were included in my pcp notes.
My pcp wrote a letter stating i had started the 3 month multidisciplinary program and then another letter stating the surgery was a medical necessity and that I had completed the program.
I sent the stull in on a Thursday and was approved the follwoing Tuesday.
The only thing is (and the other poster addressed this) is that I was told by Aetna it had to be 90 days.....no less. that is why I did the 1/12 appointment because he had told me if I would try and submit after my 12/29 appointment (which I was thinking Oct/Nov/Dec since I started 9/29) would be my three months that it would get denied...that it had to be 90 days from the time I saw the dietician.....so I went 90 days out from 10/13. I had also heard that from other people on this website who worked in insurance billing so i didn't want to chance it. Not sure it it's true or not??
Good luck to you! My surgery is one week from Monday!! Getting approved is a great feeling!
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
I worked as a nurse for 2 bariatric surgeons. Aetna does deny for less than 90 days, It happened to me twice. It was an awful phone call for me to make to those patients to tell them to come in for one more appointment! One of the patients' was 88 days and they still got denied for it not being 90!
I guess it depends on who is reviewing the case at Aetna, maybe some of the reviewers are more strict than others, but it really and truly did happen, twice.
Good luck!
Bonnie
I guess it depends on who is reviewing the case at Aetna, maybe some of the reviewers are more strict than others, but it really and truly did happen, twice.
Good luck!
Bonnie
Hey Y'all!
I recently moved to PA (Philly) from Arkansas solely for new health insurance that will cover WLS.
I have Aetna's POS Choice II Open Access and will be starting my 3 months in 2 weeks. I just can't seem to get a clear answer on one thing.
What the heck is an excercise specialist? I know where to find doctors and nutritionists, but where do I find an excercise specialist? Sure, there is that guy at the gym who thinks he knows it all; but I doubt it if he would count.
Also, if y'all have this same kind, did you have to pay before the surgery or did you get billed and are making payments? I need to know if I should start hustling now for savings or if I can get that purse I want (but really don't need).
Thanks!
Katie
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