ins requires 6 month, Dr supervised weight loss program

Aetna is requiring I provide a 6 month history of medically supervised nutrition counceling AND a Dr supervised weight loss program. Service Reps there have told me several different reasons for this. One says it is to determine if I can loose weight without the surgery-like I have never tried and this is my first attempt at saving my life. She says if I do loose weight, they will deny me because I do not need the surgery. If I don't loose weight, then they may determine the surgery would not help me, and deny it. Talk about a "rocik and a hard spot". They also will not cover the doctor or nutricional counceling. Has anyone been sucessful in over coming this requirement? I am diabetic, have lost the feeling in both feet from diabetic neuropathy, have asthma, high blood pressure, high cholesterol, fibermyalgia and cronic pain from 18 broken bones (severe trama from an auto accident that kept unable to walk for a year)

DO THEY WANT YOU TO DO A NEW 6MO DIET UNDER DR CARE OR WILL IT COUNT IF YOU WHERE EVER ON ONE LOST WEIGHT AND PUT IT BACK ON

If you lose less than 10 % of your body weight in 6 months, you should be fine. However, if we could lose weight by dieting, we wouldn't need the surgery would we? I say give it a shot. Whatever you lose will be beneficial to your health. Keep your chins up! Roberta

Hi Lori, Here's what I did with Aetna. I had everything for the requirements they asked except the 6mo diet thingy...well as soon as I could I went to a Nutritionalist (I also have diabetes) and had a consultation..also put on a 1600 low cal low card diet. 2. I started going to my pcp every month for a check up with diabetes and weighed in..talked about the diet..and each month lost at least 2 lbs...with a total of 22lbs lost in 7mo. I made sure that I weighed in each month and what my pcp documented in her chart notes...that is the key..what your pcp documents in the chart notes..then I sent in all those 6mo of chart notes..I sent in 7mo. worth and within a few days I was approved....they have no reason to deni you if you fullfill all the requirements they ask for. also make sure you highlight everything on your chart notes from weights to diets to calorie to whatever is invloved in that dr supervised diet. and also about exercise..make sure you have your pcp documents about not being able to exercise due to your feet problems..I also couldnt exercise due to my shoulder surgery I had during the time of my 6mo diet. and I had a letter from my podiatrist. get all to back yourself up. The case review nurse at Aetna who I dealt with was very nice and told me exactly what was expected...and if I couldnt exercise then make sure your dr documented it in the chart notes. Well just remember also that not all Aetna reps. are the same and say different things.. GOOD LUCK! Shauna approved. 2/19/2004

I AM CURRENTLY IN THE SAME BOAT BUT WITH A DIFFERENT INSURANCE COMPANY AND I ONLY HAVE TO DO 12 WEEKS OF SUPERVISED VISITS. FOR MY INSURANCE I HAD TO DO A NUTRITIONAL CONSULT BEFORE THEY WOULD SUBMIT ANYTHING TO THE INSURANCE COMPANY AND SO I GET TO GO BACK 6 WEEKS TO WHEN THAT WAS SO I DON'T HAVE TO DO BUT 6 WEEKS SUPERVISED DIETS. I WILL BE SEEING MY NUTRITIONIST ONCE IN APRIL AND AGAIN IN MAY WHEN MY 12 WEEKS IS UP. THAT COST ME $40 EACH TIME, BUT I HAVE TO BE WEIGHED ONCE A WEEK AND THAT WOULD COST ME $30 EACH OF THOSE WHERE AS WITH THE NUTRITIONIST I CAN BE WEIGHED AND DOCUMENTED FOR FREE. I WOULD CALL AROUND TO THE NUTRITIONIST IN YOUR AREA AND SEE IF THEY WOULD OFFER SOMETHING LIKE THAT FOR YOU. GOOD LUCK!

I also have Aetna ins. I was approved the first time. Always ask for the same person each time you call Aetna. I had to produce 5 years worth of medical records. Get your past records. Look them over... Highlight any times you discussed obesity., weight loss attempts,or health related weight problems. Fax them any Weigh****cher's records. Have you ever been a member of a gym or water aerobics, or anything exercise related. Get the leader to write a short note saying you were a member or attended. They don't have to say how often simply that you attended. If you see a foot doctor, chiropractor, OBGYN, any doctor who atributes any of your problems to weight. Go to your G.P. ask her about diets, perscription weight loss drugs. Go on their "diet" for 6 months you will lose some weight but chances are you will also gain it back. Be sure the gain is also documented. If you truly want this ...jump through their hoops. The worst thing that could happen is you might lose weight and not have to have the surgery. It is by no means "the easy way out" It is a tool and you have to do your part. You have to learn to sday no to foods that will make you dump. You have to stop eating when you feel full or you will throw up. You have to eat slow or you will throw up. Would I do surgery again??? IN A HEART BEAT! ! ! ! !