Aetna Anyone?

I need some advice. I have Aetna (PPO) and I cannot completely understand their requirements for approval. Basically I have to have 3 months of the following items. Nutritional advice, Exercise and Behavioral modifications. I can understand this and what I need to do for it but what I do not understand is the documentation they are asking for from me. They want me to meet with someone for the exercise and nutritional piece. I have met with the both of them but they said they do not need to see me again unless I have a question. Am I supposed to track everything I eat and when I work out to submit to them? I am kind of rambling here so I will stop. I think you all will have an idea of what kind of help I need.

I don't have Aetna, but the requirements sound familiar to most of us.  You should ask your doctor to recommend a supervised program of exercise and behavior modification.  Then your doctor will document your progress every month and will ultimately be able to provide this to the insurance company when they are ready to review your case. My doctor sent me to a place called the Theraputic Lifestyle Change Center.  It was basically a gymnasium with exercise physioiolgists, nutritionists and nurses.  After they meet with you, they record all of your infomation and goals.  Then they design a program for you. Good luck.

I have Aetna (PPO) and they covered my WLS in Nov 05.  I have not heard of the 3 months program.  I know they required that I had 6 months of supervised and documented weight loss program.  I had been going to the VA to a weight management program weekly with a nutritionist and psychologist.  They accepted that to meet their requirements. They also required 5 years of medical records. I know some people who attend support groups and get a document from the leader that was good enough. These insurance companies change their requirements all the time. My advice is: Get on the phone with them and find out just how you are suppose to fulfill their requirements.  Be sure to get the name of the people you talked to.  I know in my case they got tired of my phone calls, but that is not all bad. Also get support letters from any doctor you have seen the past few years.  I had letters from my orthopedic doc, cardio doc, lung doc, diabetic doc, etc. Good luck because this seems for many to be the most difficult part of having WLS.  Be persistent and do not let them wear you down. Dan

 

Dan and Jim are correct.  I have Aetna and they required 6 months of medically supervised diet and exercise.  I was able to persuade my PCP to count the time I had been seeing him already so I had counting from Feb 06 to August 06 and got approved,...mysteriously, ...in August 06.  But, the program nmust be on the correct Aetna provided forms you can get from the webiste or call and have them send them to you in hte email or electronically via email and get your PCP to fill them out monthly.. I had one appointment where all we did was paperwork.. I had my records and he compared that info to his folder on me and we Got-R-Done. I also wrote a letter to my PCP formally documenting my weight over the last ,oh,...20 years which reflected my growing girth.  This letter was of course to the PCP but for the benefit of being submitted to the insurance co from the PCP.  and lastly, because my current PCP has only been so the last year, I had to go and get copies of my records from the previous to PCP I've had and get them to my current PCP so he had documented proof of my weight and other ailments from physicans and not just my word for it.  I even wrote the letter for my PCP to submit to the insureance based on our discussion and cardiologist referral. All he had to do was copy it to his letterhead and autograph it.  So I was involved and pushed a little, but I read the rules from the Aetna website and called and talked to a nurse to answer some questions and played  by those rules to meet the insurance requirements as quickly as I could find a way to do it. Go get'em tiger!!! I'll glad get you a copy of the letter or help any I can.  You can reach me with an email so I can send the lketter id you want it as an attachment at [email protected].