Insurance junk....please answer if you can : /

  I had my consultation with the surgeon today. Before I can move forward they need to find out if I'll have to complete the 3 month multidisciplinary program. Aetna's clinical bulletin says "Aetna considers repeat bariatric surgery medically necessary for members whose initial bariatric surgery was medically necessary (i.e., who met medical necessity criteria for their initial bariatric surgery), and who meet.........." and it goes on. I had Anthem BCBS for my initial bariatric procedure. The nurse is trying to find out whether or not I have to now meet Aetna's 3 month multi-disciplinary requirement, since Anthem's requirement to meet medical necessity was somewhat different. Before, I saw a nut, had a nutritional class, went to four informational pre-surgery classes, and had a psych eval......not to mention a plethora of tests. I'm hoping I don't have to go through the whole rigamarole again : (.   I guess I just want to ask.....did you have to go through the whole pre-op regimen again to meet your insurance's definition of medical necessity if your initial bariatric surgery was approved by a different insurance?   Thanks,   Amanda

I have the opposite problem.  My insurance has given me approval but the doctors office is requiring the nutrition and psych classes again.  (I think for the $400 out of pocket.)  It doesn't make sense to me.  I would think you could call Aetna and ask for a case manager that could tell you what they require.  I think the patient gets farther when they do the calling because they are the "customer".  Demand to know and ask for an email confirmation so they can't go back and change their mind.

Thanks for the advice : )
I actually did call that day. The pretty much won't tell me anything. I don't have a case manager yet.

Hi Amanda,
     I had to go through the entire process over.  6 month supervised diet, 6 month support group, psych eval. It was very exhausting however I learned the value of support group, which I did not attend when I had the lapband.  This also gave a chance to research the RNY and other surgeries.

Thank you both for your replies : )

Well.....good ol' Aetna says I need to do the 3 month deal. Honestly, I don' t mind. It'll give me a chance to prove that I am serious, and willing to comply. I'm not doing this to see how quickly I can get approved and into surgery. I'll be glad to have the time to absorb the situation further and to better myself for the path ahead of me.