Question:
Anyone have Aetna and been through 3 month pre-surg. prep regimen?

The explanation of criteria is very vague. Do you actually have to hire an exercise specialist or can you do it more cheaply? What about the behavior modification program- what do they mean exactly? Does Aetna pay for any of this? I've called Aetna and they seem to avoid having to answer questions about criteria! Thanks for any info. Good Luck to all of you working hard to get approved!    — Cara M. (posted on June 29, 2004)

June 29, 2004
Go to your Aetna navigator on line and go to homepage before you sign in and look for policies go to weight loss surgery and read the eact language they use for approving the surgery. I have Aetna and the 6 month diet history is what they want the behavior modifcation is your physch visit and on going after surgery the exercise program is ongoing after surgery the only thing that they stick to is the six month diet histroy with physician care they are very hard about that. there policy states that if your bmi is higher than 40 with co morbidities you are covered if your bmi is 35 you have to have co morbidities for sure if your employer has not written an exculsion to the surgery they will not cover it at all. be firm and document every one you talk to and everything they say. If they blame your employer for denial go to your human resource dept they can help.
   — robinm

June 30, 2004
Look at the 3rd question down prior to yours on this board. It has some info on there that I and others wrote that might be helpful. Aetna says you can request surgery after being on 3 month diet, but can't have the surgery (meaning "get approved") till your 6 month diet period is up. I went to local PCP 2 x monthly for weighins (and got the nurses to chart the one weight), and excercised by walking and he charted this on my records 1 x(time) a month. I think by the behavior modfication, they just want to have it documented (at least monthly)that you are trying to stick to a diet. I went to a dietician that I found (good reference) from this site, THAT WAS covered entirely by Aetna. They also covered the one time psych evaluation. I got letters from both of these and submitted for the insurance. Call them sev times a wk after submitting for approval, and if denied (as most of us are), appeal and you'll eventually get approved. Good Luck!! I know you'll be on the losing side eventually.
   — bufordslipstick

July 10, 2005
7/11/05 I am currently trying the 3 month program. I am on a 800 calorie diet and see dietician this week. They started the behavior modification which is a 3 ring binder with Diet info and I keep track of what I eat. In the back of it, it has the behavor modification part. 12 weeks of info on what is good eating habits and how to eat healthy. After each week I go back in and fill out a sheet(review) if what it said and they will give me the next weeks module. I will update as I go along and let everyone know if it will work. I also have to log daily exercise and try to increase walking in the module. I am continuing for the 6 month also incase not approved I have not lost anything.
   — wmartzin