Question:
Aetna 2003 guidelines

I have Aetna insurance and my claim was submitted to them last November. I was told at that time Aetna required documentation of 6 months conservative weight loss effort. I was very upset, because I wasn't aware of this information. I got the HR gal at my husbands work involved and had a whole inquiry done. Yep, 6 months was required. I had already been attending a weight loss support group ( part of my surgeons requirements) that is run by a registered dietician. I asked if that would be acceptable and was told yes. So, I have continued to go, each Thursday night and my six months are up next week. I can resubit my claim to Aetna. My question is this: Aetna now has a 2003 guidline which requires six months of a supervised diet AND EXCERCISE program. I did not participate in an exercise program. I have been excercising. I walk every day. But this isn't documented. However, I have obviously done SOMETHING right because I have lost 39.1 pounds so far. Anybody have any insight into this? Do you think this will cause a delay in approval? I was not denied in November. When I found out about the requirement, I just removed my claim, to be submitted at a later date. Which would be March 3, and I have a surgery date of April 3. Hopefully. Thank you, Kelly    — K S. (posted on February 23, 2003)

February 23, 2003
Hi Kelly, I was just denied by Aetna for the second time. The first time, it was because I haven't been morbidly obese for five years. I had a letter from my doctor stating I had been on a diet and exercise program for six months. I hired an attorny to send in my appeal, and I was denied again. This time for not being morbidly obese for five years, and for not having a six month diet. I think now the are wanting doctor documentation of a six month diet, not just a letter. Anyway, good luck.
   — Robin T.

November 4, 2003
I have them as well but I got approved on the first attempt and I only needed 2 yrs profile from my PCP. I think sometimes it depends on the plan your employer pays. Good luck
   — Tee P.