Aetna ughhhhh HELP!!!

ROSE S.
on 8/13/13 2:20 pm - Yuba City, CA

On July 23, 2013 at 3:55 PM Pacific Time, Jen1014 wrote:

Hi all I am so frustrated with the pre-certification department for Aetna through my companies insurance. I am a nurse,so I get the needing everything in order quite honestly! I have done all my question asking to the benefit dept etc and have been advised from them to get my bypass done this year d/t all out of pocket and deductibles being met already ,so I have been going like mad fire to get everything in order. Surgeon,sleep study, letters of recommendation from all my current Dr.'s etc! You name it I got it and if I don't I can get it in 24 hours or less, this is exciting of course. You say then what's the problem? Well the surgeon asks about this medically supervised diet and I'm like a what so I call Aetna to confirm and they can't decide out of 4 calls what the rule is in regards to this criteria?? I ask for a copy of these criteria's and well you know it's against company policy so she then states I can go on Aetna's website and pull up the clinical bulletin and it's all there and basically says you can do the 6 month supervised or the 3 month Multi disciplinary surgical preparatory regimen. My questions after this long winded story are #1 has anyone been through this with Aetna and #2 is the surgeon/nutritionist/psychiatrist combo enough for the 3 months??? Thanks all for reading my long winded story.
Jen

Hi Jen11014,

I had my RNy through AETNA. I had to do the 6 month medically supervised diet, and all other requirements. The surgeon, nutritionist x1, and psych x1. was what I had to do over 6months. I would phone and inquire about the 3 month protocol.

Wishing you the best,

Rose RN

PS. see you on the other side!

mskami77
on 8/20/13 8:32 pm - AK

I have the same issue as you. Did you find out what the 3 month criteria requires? I have pcp, psych, dietitian, surgeon and weekly support groups.

noftessa0401
on 9/13/13 5:57 am - San Diego, CA

RNY on 12/27/12

I was successful in getting approved with the 3-month program, but I documented about 102 days worth, just in case. I also was told not be less than 90 days. I did doctor-supervised HMR shakes and had weekly classes ( where I met with a nurse, doctor, and nutritionist every week). As part of this program, I documented my food intake, exercise program, and weekly weigh-ins. I was approved in about 8 business days. Listen to Nan - she was instrumental in helping me get approved so quickly.

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

Aetna ughhhhh HELP!!!

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Aetna ughhhhh HELP!!!