Question:
Need Ideas on how to get around the 6 mos. physician supervised weight loss.

I have Aetna EPO and one of their main criteria are having a 6mos. physician supervised weight loss program within the last 2 years. I have been denied already because of this. I suffer from Polycystic Ovary Syndrome, Infertility, Chronic anovulation, sleep apnea, and acid reflux. Having PCOS, I have been told by several doctors, I cannot loose weight, however I can gain with no problem. Just wondering if there is some way with my co-morbids to work my way around this Aetna requirement. Any Info appreciated. [email protected]    — Amy C. (posted on March 5, 2003)

March 5, 2003
If that's the only reason you were denied, why not get yourself to your PCP as soon as possible and start getting that 6 month requirement underway. I know that's probably not what you want to hear, but it is something you can do something about and an appeal would probably take just about that long anyway. Just make sure your PCP knows why you want to have him/her document that he/she is 'supervising' your weight loss attempt.
   — garw

March 5, 2003
Hi Amy- I am still early pre-op but hope I can be helpful to you. What about having your doctor go back in time and document for the past 6 months that you have been in his/her care and the different weight loss methods you may have tried. Also, is it possible to get statements from the other docs you mentioned who said you can't lose weight due to the PCOS? One of the things I am learning in this journey is that it's important to have a PCP who documents WELL and is familiar with the wording on how to get the ball rolling. Best of luck to you! Mea
   — Mea A.

March 5, 2003
I realize you want to know how to get around it...but in the long run it would probably be better to just do it. And by that I mean have your PCP "supervise" your attempt to lose weight. This could be as simple as asking them to give you an ADA diet handout and tracking your weight every couple of weeks. Does the insurance what to see weight reduction or just the fact that you tried something for a period of time?
   — Sarahlicious

March 5, 2003
Hi, I also have Aetna EPO. I went to the surgeon for the first time yesterday. Afterward, I talked to her insurance gal. The insurance gal told me that they wouldn't even submit my claim unless I have 6 months supervised diet and exercise regimen from my PCP. On Monday, I am taking a letter that I have drafted to my PCP and asking him to sign it. I hope he does. Otherwise, I will have to start all over again with a 6 month diet and exercise regimen, even though I have lost 24 pounds on my own since September, in preparation for this surgery. I was told by the insurance gal at my surgeon's office that there is absolutely no way to get around it. Sorry for the bad news. Maybe your PCP will help you out.
   — Susan F.

March 5, 2003
I have Anthem BC BS and they required an 18 month history from my PCP. Basically my dr just put that he advised me to go on certain diets like "LOW FAT",HIGH PROTEIN, ETC.He also told me to get exercise, and he gave me water pills.If your Dr ever suggested ways to lose weight when you saw him he can document this..even if you didnt lose on those methods that would be your history.I got approved and had my surgery 12/05/03.
   — NANCY P.

March 7, 2003

   — Jill C.