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It looks like you are doing all the right things, the only thing is you can't submit in early October or you will be denied. Your first visit was really 8-15-13 so 90 days from there would be November 13th. If you submit any earlier than that it will get denied. That's what happened to me because my surgeon's office submitted too soon before I was finished with my appointments. I spoke with someone at Aetna and they confirmed it has to be 90 days, no less. I will send you a separate PM with everything I did and the letters I submitted with my approval.
You will need to schedule a NUT and a PCP appointment for 11/13/2013 or after and then you can submit after that.
Once you read through the PM I am going to send you let me know if you have any questions!!
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Sorry it took me so long, I just saw this post. It takes between 15-30 days. When my boys got approved it took 2 weeks. Because my daughter and I were denied at first, the appeal took about 30 days for a decision.
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
I’m hoping you can provide some insight. I have Aetna Select (Open Access). I am so confused on the multi-disciplinary program and every time I call Aetna for clarification, they tell me that are not allowed to tell me anything - that the pre-cert department makes those decisions. They will not put me through to the pre-cert department and tell me to have my surgeon call. My surgeon’s office called and they told me visits once/month for 3 months. Now I have read that some members were denied because their treatment was 87 days versus 90 days. Can you provide any clarification? Is it really once/month for 3 months or 90 days, and if it is 90 days, what date do I start counting from?
Sorry for the length of this but we plan to submit this during the 2nd week of October and I don't want to be denied because I'm short of 90 days if it is required. I also listed my appointment dates below. All of my labs and testing have been completed.
Thank you for any insight you can offer.
PCP
4/15/2013 (not weight related visit but did discuss it)
5/24/2013 (not weight related visit but did discuss it)
____ - no visit in June
07/17/2013 (not weight related visit but did discuss it and the decision to move forward with WLS)
08/15/2013 – visit 1
09/06/2013 – visit 2
10/4/2013 – visit 3 (next scheduled appointment)
Bariatric Surgeon
7/25/2013 – Seminar
7/29/2013 – initial appointment
10/9/2013 – Support group
NUT
8/20/2013 – group class
9/16/2013 – visit 2 (next scheduled appointment)
10/3/2013 – visit 3 (scheduled)
Psych
8/30/2013 – visit 1
9/5/2013 – visit 2
10/10/2013 – visit 3 (next scheduled appointment)
Physical Therapy
8/20/2013 – visit 1
_____ - visit 2 (have to schedule for September)
_____ - visit 3 (have to schedule for September)
World-renown Dr. Arya Sharma is the keynote speaker at our 2013 ObesityHelp National Conference on October 4-5, 2013. Below is a post from Dr. Sharma.
Just a couple of our own takeaways from the post below:
1. Don't graze!!
2. ObesityHelp provides us, as OH members, the ".....support patients towards a long-term goal of healthy and appropriate dietary choices with active monitoring (journaling) - via OH's Health Tracker.
3. Stay on track! If you find yourself off track, jump right back on!
Thanks to ObesityHelp for our OH community and to Dr. Sharma for sharing his expertise online and at our Conference.
Post-Surgery Weight Regain: Nutritional Factors
Posted: 12 Sep 2013 06:00 AM PDT
One of the key reasons why bariatric surgery is so much more effective for treating severe obesity than non-surgical approaches, is because of its profound effect on food intake.
Thus, bariatric surgery significantly affects hunger and satiety and may even have important effects on “wanting” and “liking” of high-caloric foods.
However, this effect on ingestive behaviour is neither “guaranteed” not are these effects consistent between individuals.
As I tell my patients, “The surgeons operate on your gut, not your brain”.
Thus, it can only be expected that a certain proportion of patients will struggle to control their food intake despite surgery, thereby either losing less weight than expected or putting the weight back on.
In an article, published in Obesity Surgery, we systematically reviewed the published evidence on the role of dietary factors in this issue.
As may be expected, patients reporting “loss of control” of eating behaviour post-surgery lost less weight or had a higher risk of gaining back any weight they may have initially lost. Thus, individuals with self-reported “high-adherence” scores tended to lose and sustain greater weight loss than those who did not.
Given that bariatric surgery may limit the amount of food that can be eaten at a single meal, some patients resorted to grazing behaviours (defined as consumption of smaller amounts of foods over extended periods of time) leading to subsequent weight regain. In addition, it was reported that poor diet quality, characterized by an excessive intake of calories, snacks and sweets, as well as oils and fatty foods, was statistically higher in patients experiencing weight regain.
Interestingly, even short-term dietary “indiscretion” (or falling off) can result in very rapid weight regain. This is not surprising as, in this regard there is little difference between someone who has lost weight through surgery or simply through diet and exercise. Irrespective of how the weight is lost, the body appears to retain its ability to rapidly regain lost weight if allowed to do so.
Thus, as we discuss in our article,
“The existing literature strongly suggests that nutritional and lifestyle compliance is crucial to weight management post- bariatric surgery.”
“Comprehensive weight management programs must therefore provide improved patient education and promote adherence to post-bariatric surgery diets in order to ensure success. These programs must take action to support patients towards a long-term goal of healthy and appropriate dietary choices with active monitoring (journaling) and reinforcement (review of food records) strategies provided by a multidisciplinary health care team.”
As I have discussed previously, although bariatric surgery increases the chances of success, it is no magic bullet or easy way out – all patients have to work hard at learning to use their surgery as a tool to help them better control their food intake and will likely do better, the more they understand and comply with the post-surgical nutrition recommendations.
On the other hand, there may be very good reasons why certain individuals, despite best efforts, struggle to meet these recommendations.
I will discuss how neurohormanal and metabolic factors can make dietary compliance difficult in my next post.
@DrSharma
Edmonton, Alberta
Karmali S, Brar B, Shi X, Sharma AM, de Gara C, & Birch DW (2013). Weight Recidivism Post-Bariatric Surgery: A Systematic Review. Obesity surgery PMID: 23996349
The surgeon has to put down a certain ICD code for the insurance. If he is doing a bariatric procedure he has to use a Bariatric code. There is no surgery for the co- morbidities you mention except wls so there is no surgical code for it. I doubt many surgeons would lie and defraud the insurance co in this way. They could lose their medical license for doing that.
Sorry to say,if it is excluded,it is totally excluded. There is an exclusion on my policy also,so I
Saved up and went to Mx. Best thing I have ever done in my life.
I do know at lowes and Starbucks both offer insurance to part time employees that includes Wls. Maybe you could get a part time job there?
GL
WHO IS THE INSURANCE COMPANY IF YOU DON'T MIND.I AM LOOKING ALSO
it specifically says Exclusion....Surgical and non-surgical treatment of obesity. Well could the doctors say it's a treatment for my chronic hypertension, degenerative knee problems, incontinence, and sleep apnea to get it approved without saying it's spefically for weightloss?
Has united healthcare ever paid for any type of bariatric surgery? I think it is a specific exclusion on my policy. But I was wondering will they pay for the cost surrounding the surgery such as the facility fee and the other things and I just pay for the cost of the actual procedure? Can this be done?I want and need this surgery really bad and can not afford to pay cash. Are there any charitable services that will help. I am desperate.,,,