Aetna help...............

I am so fed up with aetna.They are trying to screw me every which way!!!! Not only have they denied my surgery because they didnt like my pcp notes they didnt think they were detailed enough.Pcp spoke to medical director and personally went through my weight history.He still said he was going to deny it. Then I get the denial letter and it states it was denied because their was no proof of recent weight loss attempts. First of all he never said that to my pcp. Second,9 mos out of the two years they want the notes for I was pregnant! Third, before that I was following a very sensible low carb diet and exercising at the gym 3 to 4 x's a week!!! Plus I was on glucophage because I was trying to get pregnant and I have PCOS. I was also on fertility for some time before that.So these fools want two years worth of notes and at that time I was on fertility and gluc plus eating sensibly but not doing anything through the doc because I was trying to get pregnant.What about the 18 years before that? There has not been a time that has gone by(other than my pregnancies) that I havent been on some sort of diet.Now I am told I might have to go on a 6 month medically supervised diet!!! Its a waste of six mos! I should have had my surgery over a week ago. Any input on this would be appreciated.Especially if anyone knows a good way to deal with it.Thanks! Lorie

Lorie, I got approval from Aetna after my econd appeal. I sent you a private e-mail with the details. Don't Give Up the Fight!! Krista

Hi Lorie, I just wanted to let you know that I am fed up with them as well. They seem to create new reasons for denials. I have heard so many different ones from them my head is spinning. Don't give up. Thats what they want you to do. Get legal help if needed. Good luck. Amy

I keep hearing that Aetna will no longer cover it at all as of Jan 1 2005. I just cried when I heard that. But the information I keep hearing is, of course, conflicting, so I don't know who to believe... I just read that someone was approved just this wee****ep up the fight!

Hi Shana, I am not too sure about that. But I know I have heard that Aetna, as well as some other companies, Will not be covering any WLS. as of 1/2005 When I called Aetna about that they said my plan still covered WLS as long as I met their criteria. So I guess you would have to see what exclusions if any your plan has. And depending on who you talk to because no two people give you the same answers at Aetna. Thats the way it seems at least. Good luck and don't give up. Amy

Aetna will not cover bariatric surgery _automatically_ as of January 1st. Each company must purchase a specific WLS rider for its policy. If a state requires that WLS be covered, then it is covered (I think only a handful of states do so). I have Aetna through my husband's employer, and it did purchase the rider. Lorie, I know it really stinks to be forced into the 6-month diet. But that time does pass! I'm a week and a half away from finishing mine. I've used those six months to learn all I can about post-op life (thank goodness for OH!) and to attend multiple surgeon info sessions before selecting the one who suits me the best. Even if you plan to fight for approval using your current records, start a doctor-supervised diet NOW. Get to your PCP's office as soon as you can, do the official weigh-in, and make certain that your doctor makes CLEAR, DETAILED, and LEGIBLE notes in your medical chart on what diet you will follow and what exercise you will do. "Patient is on a diet" and "Patient does regular exercise" is not enough; "Patient is on the following diet: 1200-1400 calories per day, no sugar or starches, 70g-90g protein daily" and "Patient walks 2 miles a day, 5 days a week" is much better. Have your PCP state your co-morbs (if any) in that day's medical record, even if they've been noted previously. Once a month, go back to the PCP's office to weigh in... and have your PCP include your diet and exercise information at every single visit, even if you haven't changed anything. If you see a nutritionist or join a gym or consult with a personal trainer, have your PCP note that in the record as well. Ask to see the actual notes on each visit to make sure everything is written down and readable. Give Aetna no excuses for denying you! (and yes, they have denied patients because the PCP notes were unreadable) FYI, Aetna has a second option, which is a 3-month multidisciplinary regimen that includes a nutritionist-supervised diet, a supervised exercise program, and a behavior modification program, all of which are supervised by your PCP. Some surgeons' pre-op programs qualify, or you could put it together yourself. The guidelines on Aetna's site aren't entirely helpful, though (they don't specify how many times you must see the dietician, psychiatrist, and personal trainer).