Aetna....

How do you deal with Aetna for approval. I do not want to wait another 6 months for approval. It is to my knowledge that you have to have a recent 6 month weight loss plan supervised by a your doctor. I have been doing weight loss plans all my adult life. I just can't do it some more. This will just make me more depressed. My doctor tells me that they might not approve the banding so I will have to appeal it. What's up with that.

I know for a fact they will not approve with out the 6mo dr supervised diet..I am one of those that didnt do a 6mo diet and didnt know about it either...but instead of fighting with them ...the case review nurse told me to just do the 6mo she'll close my case so i'm not denied, I know that aetna thinks that lapbanding is expiermental just like they would'nt approve the lap RNY, well now they are...they are always changing the requirments, I always check up online to see if there was any changes...well I just got done with my 6mo dr diet and my surgeons office faxed it off on Feb 2 and then they had a update online on Feb 3rd. so none of it will pertain to me...all I know is I have fullfilled all the requirements they have asked and I even lost 25lbs in my diet and i'm prepared to hire walter lindstrom. I'm sorry if I wasnt more of help. Good Luck On Your Journey!!! Shauna

Hi Shauna, I just read your post about doing the six month diet. I too am on Aetna. I haven't done the six month diet. Right now I'm trying to decide whether to do the six month diet or the three month presurgical regimen. With the three month presurgical regimen, you have to do a diet that is supervised by a dietician. I believe that means I would have to see the dietician regularly. It would be an out of pocket expense for me to do that. Also, this three month diet requires an exercise plan supervised by an exercise therapist or other qualified professional. What the heck is an exercise therapist? Would I have to hire a private trainer? Again, another out of pocket expense. I called Aetna to ask about that and was told that my PCP could qualify as the "other qualified professional" needed to supervise the exercise program. I've been told things by Aetna before, only to be told something different the next time I've called. So I don't exactly believe what they tell me. I was hoping you could tell me what exactly it was you had to do to fulfill Aetna's six month diet program. I might just do the six month program even though it would take longer and push my surgery back to October at the earliest. The six month program seems more simple and straightforward. It seems more likely that I would do that one right. I'm afraid I'd do the three month program only to find out I didn't use the right qualified professional or something equally moronic. Hope you can help, I'd appreciate any help you could give me. Thanx, Lynda D.

This is my first visit to this site and I am so happy to find that I am not alone. I have received the same letter you did. After two hours on the phone I gave up talking. One person told me that the supervised weight loss program was a requirement to determine if I would be successful with the surgery.. .. so I guess, if we loose weight temporarily (haven't we all?) we will be denied because we don't need the surgery to loose weight. If we do not loose weight they will deny it because we are unable to loose weight. They had no answer for me when I asked how attending the supervised weight loss program would prove that I followed the "diet". I may have found a doctor next door to a Dairy Queen!" I am now trying to write an appeal letter. I say "try" because everytime I start, the tears start to fall. I do not have any words oif wisdom for you. We are in the same place in our journey. Keep trying. Good luck.