aetna info

 I have aetna, and would like to do the 3 month plan but I am a bit confused on some items, I would like to seek some wisdom.


Behavior modification program supervised by qualified professional; do you know if that could mean a licensed clinical social worker  or what that could entail

Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and could that mean a YMCA membership, with my medical issues it is hard to exercise 

Consultation with a dietitian or nutritionist; and  Reduced-calorie diet program supervised by dietitian or nutritionist; does this mean 3 months of visits or just 1 the way I read it is just one documented visit   I have contacted aetna and they have just referred me to the Clinical Policy Bulletin:
Obesity Surgery Number: 0157 which I have read   Any help anyone would be willing to share would be great

thanks in advance

Hi,

I was approved on Aetna's 3 month multidisciplinary program. and my daughter just completed it and is waiting on approval.

Behavior modification program supervised by qualified professional; this needs to be documented in your PCP's notes the behavior modifications you are making to ensure success for the surgery.  This can include things such as not drinking with meals, eating smaller portions, joining a support group (OH is a good one!), taking smaller bites and chewing your food, increasing fluid intake to 64 oz a day.  Anything like that which is a behavior you will have to modify to be successful after the surgery.  Just make sure your physician is documenting in your office visit notes and words it as 'behavior modifications xxx is working on is xxxxx....."

Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional;  What I did for this one was through work I was able to join the gym.  I had the exercise specialist there set me up on a weight training program and cardio program and write a letter to my physician stating that he had done so.  Again, they look at your physician's notes so make sure everything is documented in your physicians notes.  In your case, if you have a YMCA membership, make sure that is documented in your physician's notes.

Consultation with a dietitian or nutritionist; and  Reduced-calorie diet program supervised by dietitian or nutritionist: I was fortunate because we have a registered dietician here at work so I did not have to pay.  But yes, you need to have a visit with a dietician who discusses a reduced calorie diet and exercise program.  What I did was have the dietician write a letter to my physician stating I had seen her and what we had discussed.  She also had the notes from our visit which were given to my physician.  Your physician is the keeper of all records, basically.  So everything must be documented with your physician.  I did go every month to the dietician.

So in a nutshell, what I did was:

Physician visits - 4 visits (1st one doesn't  count as a month)

Dietician visists - 4 visits with her (I think you can just do 1, but I did 4)

Exercise - make sure your PCP is documenting something about your exercise in the physician notes.  Even if it's "XXX walked three times a week this month for 1 mile" 

Behavior modification - make sure there is something in the physician notes about your behavior modification such as examples given above.

Make sure also that your appointments are 90 days apart.  They say three months, but it MUST be 90 days (Aetna specifically told me this)  It must be 90 dyas (or more) from the day you start to the time you finish or they will deny (even if it's 89 days :-)

Hope this helps, and good luck to you!!

Nan

 

Is it 90 days from the first time you see the PCP?

Yes, it is.  I went to 4 visits with my doctor and 4 visits with my dietician.

I have Aetna too, I am currently in month 2 of my 3 month program. At my hospital that I will be going through, they have a bariatric program and building that is setup with everything to do the 3 month program and with all the correct and qualified people. So the first month, I did a Physciologist led support group meeting, exercise evaluation, and a nutritionist evaluation, also I had to do a Surgeon consult at the beginning too. I go today for my second month, and today I do my support group, nutritionist eval, and exercise eval, and of course all three times I have to weigh in too. At my third visit, I will have a group support meeting again, nutrition eval, exercise eval, and a surgeon consult to close it out.

I was wondering this EXACT same thing. This is my fourth month out of six, so next week, will propose this to the staff at my surgeon's office. Wish me luck...best wishes to you!!!

Good Luck, Please let me know what they said

Hey, sorry, did not notice your reply for some reason. I talked to one of the nurse navigators at my surgeon's office, and she said that you have to see the dietician, and an exercise physiologist one time each month for three months. So, since I am more than half way through with the 6 month program, I am just sticking with that. I now only have one month left. Have you decided on what you want to do?