Question:
Gallbladder, WLS, AETNA's new regs as of 1/17/03.

Has anyone been working on AETNA's 6 months supervised diet + dietician, while waiting for WLS - AND had gallbladder (stones) pain/nausea - AND been approved for surgery of both before the 6 months was up? I am just now getting a referral to see a dietician through my primary care - but I have an appointment at the surgeons in 2 weeks due to the gallbladder problems, and for the WLS. Just curious if anyone has had the same problems under AETNA's new regs and been approved earlier than 6 months. I'm really worried about having to take time off for two separate surgeries!!!    — Tina S. (posted on March 5, 2003)

March 5, 2003
I am not sure how strict they are being about these new rules. I can tell you that with the Plastic surgery, I was told that they probably wouldn't cover my arms and that they really only consider an abdominoplasty with medical necessity. That said, I was approved for both my arms and stomach with no problems and they feel that the other procedures will be covered as well (hips, thighs, butt, and breasts). I know this really doesn't answer your question, but I figure if they were quick to cover these procedures for me, then maybe they are not as strict as everyone thinks. Just my thoughts (of course, the type of policy you have may make a difference - it depends on what they have requested be covered). Another thing, when I had my WLS under CIGNA HMO, they said a 6 month physician supervised diet was required and I didn't have that either. I was approved pretty quick and they didn't give me any problems. Good Luck!
   — Beffy W.

March 5, 2003
I had a similar problem. My gallstones were large and numerous and after having an MRI, I was allowed to have not only the gastric bypass but they took out my gallbladder at the same time! If the stones are large enough (not sure what they thought were large enough) they most likely will approve both since it is cheaper on their part to allow both at the same time.
   — [Deactivated Member]

March 7, 2003
I just got approved for surgery last month under Aetna. It only took 10 days. I did not have a supervised diet history but my surgeon suggested that I write up my diet history and she sent it to the insurance. Good luck on your try.
   — Melanie S.

March 26, 2003
I am today sending in a grievance letter to Aetna for outside review. There is a chance that it can be approved still by a nurse that looks over all the letters. I filed under the former guidelines and my request is being denied under the current guidelines. I have a statement from my PCP office that an Aetna Dr. said I would have been approved under the former guidelines! I will post my results when they come in.
   — toni S.