Question:
I have 1 more month to go on the 6 month Aetna required doc supervised diet.

Aetna denied the surgery in Feb because I didn't have a 6 month doc/dietician diet program documented. I now have 1 month left on the "diet". Should I be contacting my surgeon now? Should I just wait until I complete the 6 month program? What should I be doing now?    — greg17 (posted on July 10, 2003)

July 10, 2003
Once your six months is up, write a letter to your insurance company (use the address from the denial letter) saying that you have now completed the required six-months of monitored dieting, and to now please reopen the request for approval - and send them copies of your medical documentation. Then, call them in a week or so to make sure they received the info, and to check on what they're doing about it. Once you are approved, call your surgeon for a date!
   — bethybb

July 11, 2003
I had scheduled a consultation with my surgeon back (phone call in 6/03), and since he is so booked, the appointment is not until January, 2004. LUCKILY, his staff warned me of Cigna's 6-month required Dr. supervised WL requirement during my first phone call. So, I can do the 6 months "diet" and then get right in to see the surgeon. ***I would suggest calling your surgeon's office, and setting up an appointment that will be just after your 6 months are done*** It will take a few weeks at least to get you into surgery, and you will have hopefully met all the ins requirements then and be approved...if not, all the surgeon has to do is bump your surgery date back while they wait for your approval. Just my thoughts... GOOD LUCK!!!
   — Susan B.

August 26, 2003
Now that I have fully met their requirements. They are saying the my participation in the program was insufficient. My employer has agreed, thus upholding the decline. So I am being advised to try again next year. I have decided that they could try the same thing next year and my fight would be that much more difficult. They, my employer and Aetna, have not given me any guidelines for what is acceptable, only that what I have done thus far is not acceptable. I am challenging this crap on the grounds that they never provided me with any guidelines of what was an acceptable physician supervised program and/or what level of participation was expected. My program consist of an endocrinologist, surgeon, nutrional nurse educator and the use of an exercise physiologist post-operatively. Although, I don't think it would be a problem to see them before hand. I just have chosen not to. I joined a gym and utilize the instructions provided to me by my nurse educator/nutritionist for my exercise plan. This is unbelievable. I qualify and then they come along with some unknown criteria to determine my eligibility. I AM GOING TO REPRESENT MYSELF IN COURT SINCE I CAN NOT AFFORD AN ATTORNEY. WISH ME LUCK!!! Felicia Underdue
   — aflower1

August 26, 2003
I was recently denied and then approved by Aetna because of their new guidelines. My initial request and denial was because my surgeon's office didn't include all my records (they "lost" them somewhere in the office). This is what was included in my appeal:<P> All the records from my current PCP from 2/2001 when I started seeing him. His transcipts from my visits are what sealed the deal for me, I'm sure. In his notes he included my weight, if I had gained or lost since the last visit, what food issues I was having, if I was exercising, when and how much, what I was doing to control my diabetes, my attitude toward my gains/losses and general comments about my support system and how I was feeling. He is an incredible doctor and I am very blessed to have him. I know that if his notes hadn't been so good, they might have denied me again. My previous doctor's notes were horrendous and if I didn't have to prove the 5 year history of obesity, I would never have included them. I saw the man for 7 years and when I requested my whole file, his office sent about 5 pages of notes, front and back. My 5 year old niece could have done a better job. <P> I said all that to say this: in my experience with Aetna, I feel like my doctors notes made all the difference. Make sure your doctor has documented all your visits, weight gains/losses and discussions about food and exercise. When I was getting my appeal ready, I talked to my caseworker and asked her for specifics about what they really wanted to see. She said they want details. If you have charts of your weight loss from the doctor or dietician visits, include those. Just flood them with information. I sent old and new PCP files, pictures of me throughout my life, proof of my membership in a women's fitness center, and a long and detailed appeal letter. (Let me know if you think it would help you and I'll email it to you) After receiving everything, they had to answer me within 15 days and I was approved. <P> I wish you the best, just don't give up.
   — Tammyjo

March 18, 2004
I have run into this and this is what I found out. This is through (obesitylaw.com) and the lawyer is Walter Lindstrom. with the research they technically cannot require you to do something that they exclude from paying for in order to qualitfy for treatment. It's called basic plain and simple discrimination.The lawyer can cost as low as 300.00 for their help. You need to go to that site. Best of Luck!!
   — Cindy L.