Aetna's 3 month Regiman

My question is...Do I just decide for myself that I want to do this? Or does Aetna approve me for that program rather than the 6 month supervised diet? 

What I've done so far is have my PCP write my surgeon a letter stating that the surgery is medically necessary and that I've started the 3 month multi-disciplinary regiman. I see my surgeon for my 1st consult appointment on 6/8. I've already had all of my other necessary appointments.

I hope you guys understand what I'm asking!

I had to take charge when I did it.  The doctors are much more cooperative when you tell them exactly what you need and why.

I had to make sure the appointments happened in consecutive calendar months and I also had to make sure my dietician and PCP were sharing info with each other from the appointments.  Certain docs office staff tried to tell me what I needed (incorrectly) - I just explained that my insurance company requires certain things and I did my homework so I know what I'm talking about - they backed off and said OK.

There is no one to ask permission from - just do whichever works for you - the 3 or 6 month option. 

Good Luck!

I am in the same boat as you.  It's crazy!  I keep getting different information depending on who I talk to (Aetna vs doctors office).  I think the process is to have all of your records (including the 3 or 6 month progress reports and the letter of medical necessity) and then submit for approval.  I think it's up to you whether or not to do the 3 month or 6 month regimen. 
Can you please let me know how your process is going?  If you submit to insurance before the 3 months, let me know if you are approved. 
What are you doing to meet the Behavioral Modification and Exercise Therapist requirement?  The info is so vague that I don't know who to see and how often.  The Nutritionist part seems pretty straight forward.  What is your surgeon's office saying to do?  Thanks!

Cathy

I am in my first month of the e month multi-disciplinary regimen.  Here is the order in which I'm doing every thing.

1.  Last month (April) I went to an educational seminar that the surgeon (who will be doing the surgery) puts on every month. Then I went in to see my PCP to let her know that I wanted the surgery, and to get her on board.  She said to let her know what she would need to do to help.

2.  This month I started the 3 month regiman with my first apt. being with the Surgeon.  After I met with him I talked with his "patient advocate" who handles insurance etc.  She went over my plan with me and was able to refer me to a physical theripist, a nutritionist, and a counselor.  I've seen all three of these this month, plus had another visit with my PCP so she could weigh me and document that I had started the regimen to prep for surgery.

3.  I set up monthly appointments (June and July) with each so they could moniter my progress.  Each being the PCP, the phisical theripist, the nutritionist, and a counselor (for behavior modification).

At the end of the three months, my surgeons office will compile all the necessary documentation and submit it to the insurance company along with a letter of necessity.  

I'm sure that everyone realizes that we're just jumping through the necessary hoops...but oh well.  I decided that if I have to do it anyway, I might as well try to get something out of it!  

Oh and to actually answer your question....you can decide which program you want to do.  :)  Good luck and keep in touch!  It sounds like we are on the same track.
  

1. First, I went to the seminar. I have an appt with the surgeon for consult on June 8th.

2. Second, I had an appt with my PCP to document my weight and let her know that I'm interested in the surgery and get her on board.

3. Next, I had the gallbladder ultrasound, psych consulation and appt with the Nutritionist. Seeing the Nutritionist on 5/19, I made that the start of my 3 month Multi-Displinary regiman.

4. I had all of these specialists fax all notes and results to my PCP, who will then forward all of that along with her letter to my surgeon for June 8th.

5. I have all of my appointments set up for the next 3 months, with my PCP,  and Nutritionist. For behavior modification, I was going have the Dr. write that I joined a local support group as well as the online support group. But I think just to cover my ass, I'm going to see a therapist once a month as well. For the excercise specialist, Im not sure about that one. I discussed an excercise regiman with a trainer at my gym.We actually sat down, she took my BP and we discussed me losing weight. So Im thinking , just have her write me a note on company letterhead about the excercise regiman Im doing...Not sure if that will be sufficient. Maybe keep an excercise log as well?

I think I have everything covered, if Im missing anything please feel free to let me know. Any advice is greatly appreciated! I welcome all questions too.

Aetna requires just one visit with the psychologist.  Please have your surgeon refer you to a specialist to evaluate you.  The support groups will not cut it.

Good Evening!

I am currently doing the three month Aetna approved program myself. It is offered through my bariatric surgeon. His Registered Dietitian and a Physical Therapist teach the class. The way it was explained to me is that Aetna requires a weight loss program under a doctor for six consecutive months. I did that in 2008 through Physician Weight Loss Centers but unfortunately I was two months short of the six month criteria. So I HAVE to redo the weight loss program through Physician Weight Loss Centers but for six consecutive months or I can do the three month weight loss program offered through the bariatric surgeon. Of course, I chose to do the three month program.

Apparently, Aetna chooses certain bariatric surgeons to offer an Aetna approved three month weight loss program. You need to find out if your bariatric surgeon is one. Otherwise you can have your Primary Care Physician monitor you for six months. But he has to record your blood pressure and weight. He would also need to do patient education with you on exercise and nutrition. That must all be documented for six months.

The three month program is super easy and very informative. You meet once a month for three months to be weighed in and listen to the Registered Dietitian and Physical Therapist educate you on so everything. I assume all Aetna approved three month weight loss programs are the same.

What you are doing sounds great but I am sure the three month program has to be Aetna approved and through the bariatric surgeon. It would be nice if we could do it on our own and then go and have our surgery but insurance companies do not want to pay for this surgery so they do not make it that easy. Darn Aetna! :(

And then again I could be wrong. My information could be incorrect. I hope it all works out fine for you.

well i have aetna...and i want to get the lapband done and the financial worker from the hospital im doing surgery called atena...they say ou have to have a medically write and supervised diet....however she asked me to get weight for the past 2yrs i have been with my doctor and have my doc write a letter ( because he knows the process, we works with this hospital and obesity) so maybe there is a loophole somewhere....i actually have to see my pcp tomorrow so ill let ya know!

My surgeon's office tried to tell me I needed to provide a five year weight history and do a six month supervised diet. I told them NO, Aetna only requires a three month weight history and a three month multi-disciplinary diet so that's what I'm doing. I was approved with absolutely no problem.