Aetna Qualifications

I have a question about qualifying for approval of RYN throught AETNA... I have been heavy for all of my life.  Along with yo-yo dieting I have never really had a BMI under 40 in the past 10 years.  I also have been to doctors, but not very regular since about 2001.  I was wondering what kind of problem this will cause me?  I was weighed in 2007-2008, then pregnant in 2008 and weighed once in 2009 and now in 2010.  I am jsut really worried about the approval process.  I am just starting my 90 day program.  Thanks!!

I replied to you on the RNY board also, but feel free to PM me if you want additional info.  I have Aetna and both my daughter and I did the 3 month multi disciplinary program.  Both of us were denied at first, we applealled and then were approved. My son is currently doing the 3 month multi-disciplinary program and hoping to be approved to have surgery in Dec.

They have a clinical bulletin (0157) that spells out the requirements. You can get a copy of that by going onto Aetna's website and searching for 0157.  You will need to see a dietician and document with your physician your exercise and behavior modification. also, I had talked with a representative from Aetna and thy said make sure your appointments are 90 days apart (from start to finish) or you will get denied.  So you have to go monthly after your initial visit.   Make sure that final appointment is more than 90 days out from your initial visit or you will get denied.  If it is 89 days, they will deny you. Just some things I learned going through the process with both my daughter and I. 

 As far as obesity history, you need to show a two year history.  So you would need to show weights from 2008, 2009 and 2010 with BMI's over 40 if you do not have any co-morbidies.

If you need any ifo, fell free to PM me.

Thanks for all of the great info.  I think I can get those weights.  I am so paranoid because I really want this.  Thanks again

 I also have aetna and I am really nervous that I will be denied. I do have co-morbities that will help with the approval. I just want to make sure that all my drs visits are well documented so that I don't have to wait an additional 90 days.