Aetna - Help?

Hello all!

I'm kind of in desperate need of help and I'm hoping that someone on this forum may have already gone through this and can share their experiences with me, just so I feel more confident in what I'm doing right now.

Basically, my company is switching to Aetna in January, at which time I will be able to finally get weight loss surgery.  Aetna has the three month multidisciplinary option that I'm trying to do right now, but I'm not clear about what I'm supposed to do (the wording is a bit confusing).  So far I've seen a nutritionist and my primary care physician, but I was wondering if I had to join a real gym for the exercise requirement and if I had to see a psychologist/psychiatrist for the behavior modification part.  My PCP didn't seem to think that was necessary, but with all of the insurance horror stories I'm hearing, I just want to make sure.

The only reason I haven't called Aetna yet is because they're not actually my insurance company yet.

I guess I'm just asking for someone who has already gone through this to share their experience, what they had to do to get approved.

Thanks!!

I, too, am switching to Aetna in January and have the same multi-disciplinary option (vs. the 6th month supervised diet).  I called my surgeon's office and she explained it to me, telling me that everything could be handled from their office.  So, I think your best bet at this point would be to ask the surgeon's insurance coordinator, if you have one picked out.  They might be able to arrange everything for you.

BTW, the insurance coordinator at the surgeon's office said that Aetna was great; that they haven't had any problems getting people qualified for the surgery.

Good-luck!

Thanks for your response!!

I have talked with the surgeon's insurance lady and she gave me some forms to have my Dr. fill out, she even gave me a copy of a letter (names blacked out of course) that another person used to get approved for surgery.  The thing that makes me a little nervous is just whether or not I need to see a psychologist or join an "official" gym in order to qualify for this surgery.  The insurance lady and my Doctor said I didn' tneed to see a psychologist and they said it was okay to just walk rather than join a gym.  According to the paperwork, consulting with a dietician constitutes as behavior modification.  I guess I just thought that meant seeing a head doctor.

Like I said, with all these insurance horror stories, I just want to make sure that I don't spend the next three months working towards this only to find that I wasn't doing it right.

Hi hope this helps. I have Aetna and was just approved last week and had my surgery on Tuesday. It is good if you already started seeing your nut because guess what?? That counts. Just make sure you keep seeing your nut each month you do the visit and it's documented it counts.I started at the end of July with first a visit to the surgeon which then referred me to the nut. But your PCP should count. After that I went every month up until the end of October. I didn't join a gym. My nut had me keep track of exercising daily. Like walking for 10 minutes each day I kept a calendar that I submitted to her each visit. Or if you do work out document what you did and for how long. Also keep records for each visit of what you ate such as calories etc.., Once I finished all the requirements which I only lost 3 pounds they submitted my paperwork less than 2 weeks ago to Aetna and it took 3 days for approval. I called everyday to find out the status. Basically I was obsessed but I got the approval I was seeking. 3 months was alot better than the 6 some require. Just stick to what you are doing and make sure they keep up with your records and they see you are trying. Good luck!! If you have anymore questions feel free to ask me.

Oh one more thing you should be able to see the psychologist anytime between now and when you are ending your 3 month visit. I saw mine in the middle of the 3 months. He actually worked in the same office as the nut so I did everything at one time. I was nervous and scared at the visit but it was suppose to be 45 minutes. I was there for 15. They basically want to know if you understand what you are about to go thru and can handle the change.  I was told I was fine and that is sounded like I had to all ready together. So just go in and be yourself and be prepared for this life changing event.

Thank you SOOO much, that's exactly what I was looking for.  Good luck with your surgery, hopefully I won't be too far behind you!!!

I was approved by Aetna also.  The 3 month thing took me almost 5 months because I had a hard time finding a surgery friendly nutritionist to work with me.
I did the following:

PCP - met with him monthly.  He was the gatekeeper for everything.  I gave him my calendar with my exercise schedule.  He received the notes from the NUT and did the package to be sent to the surgeon's office

NUT - detailed all the behavior modifications I had been working on (eating slower, drinking more liquids, taking vites a few times a day to get used to it, eating more protein).  Every week I would send her my eating plan.  We met monthly.

Support group meetings - I went to the surgeon's 2 monthly meetings and made sure I signed in and they noted I was there.

I was approved after 24 hours.  I do know someone who did the following but I would not have taken the chance.  Had January 28th appt, Feb 4th appt and March 1st appt.  Since each appt had a new month it was approved. I did mine 30 days apart.  I didn't want to have to appeal.

Good luck,
Cathy