Aetna 3 month presurgical preperatory regimin??

Hi! I just got an appointment with a surgeon, and am going to try and get approval from aetna with the 3 month presurgical preparatory requirement. (Its a mouthful! But its what aetna lists on their policy bulliten) Anyone had any success getting approved with the three month vs. the 6 month? Any pointers? Just curious! Thanks for your help! Theresa Johnson

Jan... Thanks for responding! Can you tell me exactly what you did as far as documentation goes? I am not sure how to prove behavior modification and excersise and diet? I have called and asked aetna, but their answers were to look at the policy bulletin, which is like greek to me! Any help you can give me would be much appreciated! Theresa

Theresa... A friend of mine did.. and she was approved first time! Best of luck to you! Erin Midland, MI THe Aetna WARRIOR

Hi Theresa, I did the 6 month diet although I had originally intended to do the 3 month. When I resubmitted my paperwork, it wasn't that many pages but it was clear and concise & asked for what they needed. Make sure you go see your PCP each month (do not skip!) for weight loss appointments only. Make sure that they are clear that this is an appointment solely for obesity. Your PCP should document your weight, exercise progam info and any nutritional information. Make sure that you also make an appointment to see a registered dietician or nutritionist every month. Join a gym and have a trainer write out a program for you. Keep gym receipts as well. As for the so called mystery "behavior modification" maybe look into weigh****chers or Jenny Craig, or Nutrisystem. Also , if you quit smoking or stopped eating sugar, make sure that it is in your PCP's notes. I actually think the key to this is to make sure that you have a PCP who supports your decision and willing to assist you with this very important record keeping. It might sound like it's not alot but it is pretty intensive which is why I think some chose to opt for the 6 month. Good Luck, Court

Thanks everyone for responding! My appointment is on Weds. this week. This dr. is based in a hospital, so I know that he has nutritionists and stuff on his staff. So, my plan is to go there with my policy bulletin in hand and tell him what I need. Hopefully to see his nutritionist, and then since his program fee includes 3 months use of the hospitals workout place, I will start going there and keeping records of what I do. The only mystery is the behavior modification. I am going to call Aetna on Monday morning and ask them what that means, I am "guessing" that it means going to a psychologist of some sort to talk about my food problems, but I really am just clueless. I'm hoping that's what it is though, because my policy will pay for a psychologist at 90%. If it means jenny craig or something, I am in trouble because we really don't have any extra money. I have used it all to pay this stupid program fee! Anyway. Wish me luck. I will write if I find out anything from Aetna on Monday.

Concerning the behavior modification... I attended a nutrition class that focused on post-op diet and eating behaviors. They asked me to sign my name to commit to a few changes in behavior PRE-OP. They were: * Removing soda from my diet * Eating 3 meals per day * Taking at least 30-45 minutes to eat one of those meals * No drinking 30 minutes before or an hour after a meal Again, these behavior changes were to be effective immediately, even though we haven't yet even submitted for insurance approval. It is my take that this is clearly a behavior modification plan.

Hi, I talked to Aetna this morning. The guy that I talked to said that he could "explain" but not interpret the clinical bulletin. My take on that was that Aetna reserves the right to interpret the bulletins however they want. My Pcp started documentation today as to my height, weight, bmi etc. I see a registered dietician tomorrow morning. The behavior modification is supposedly with the dietician and a pre surgical psych consult. I asked if Curves would be acceptable for the exercise regimen and he said it didn't necessarily have to be an organized exercise program..it's whatever program your dr. prescribed. If your Dr. says you are limited to walking around the block twice a week that should suffice. However,,,,,my Dr. thinks walking & Curves would be a great start for me. My PCP has never done this before so he wasn't sure what his part was. He agreed to see me today as a starting point, again in Aug as a mid-way point and again the end of Sept. as the end of the 3 month program. I have to continue with the dietician either weekly or bi-weekly. I can only imagine what this is going to cost me. Even if the 3 month ""multidisciplinary surgical preparatory regimen""...(what a joke) doesn't work, I'll just continue with a 6 month thingy. Oh, the other thing that I wanted explained was the term cumulative 6 month program with diet & exercise. I wanted to know if doing 3 months of diet and 3 months of exercise would be equal to 6 cumulative months and he had to get a clarification. His supervisor said yes. Or it could be 2 months of exercise with 4 months of diet. So,,,hopefully I can play their game properly. My surgery consult is Aug 9.

I hate to say it but I wouldn't take the Supervisor's word on 2 months exercise/ 4 months diet, etc... the 6 months should be exercise, diet, & nutrition all at once supervised by your PCP. The last thing you want is to have insufficient information. At they point they won't even be trying to hear that that is what someone told you when you called 6 months ago. You don't want to just take one person's word. Make sure all angles are covered. DO NOT GIVE THEM ANY ROOM TO DENY YOU!!!! Good Luck!!!! ~CK

[quote]Oh, the other thing that I wanted explained was the term cumulative 6 month program with diet & exercise. I wanted to know if doing 3 months of diet and 3 months of exercise would be equal to 6 cumulative months and he had to get a clarification. His supervisor said yes. Or it could be 2 months of exercise with 4 months of diet. So,,,hopefully I can play their game properly. My surgery consult is Aug 9. [/quote] DO NOT BELIEVE THIS! IT IS TOTALLY 100% PURE B.S.!!!! YOU NEED 3 OR 6 MONTHS OF [U]EACH[/U] REQUIREMENT.

In order to complete the 3 month program, you HAVE to see a psychiatrist once a month for 3 months as well as your PCP and a nutritionist. Also, they are tricky with the wording, you have to see each of those doctors 4 times, not 3. The first time is when the 3 months start, then you will need a vist AFTER the 3 months is up, totaling 4 visits. So, for example, July 15 - visits with PCP, psychiatrist and nutritionist to get program started August 15- visits with all 3 September 15- visits with all 3 October 15- visits with all 3 I work with someone who was denied because the first visit essentially did not count, so make sure you have that 4th visit. Also, your nutritionist should be documenting your exercise in her office notes as well as your PCP and psychiatrist.