Question:
I currently have Aetna insurance (HMO) and wanted to know if I have to directly

contact the company or will my doctor do it? I also have a similar situation concerning one of the postings. I have a BMI of 41.8 but I haven't been on any supervised diets, but I have tried other methods. How am I supposed to document this information being that there isn't anyone to account for my dieting?    — melanie G. (posted on July 2, 2003)


July 2, 2003
I have Aetna's coverage policy bulletin listed on my profile. You must meet this criteria in order to be approved. Please feel free to contact me with any questions (I work for them too). Good luck!!
   — vampyre200

July 2, 2003
The way I got around this was to contact all the Drs I had gone to in the last three years, PCP - GYN - Pulmonologist, etc. and ask for a copy of my file showing the dates of my visits and my weight at that time (they always weigh you even if you are going for a sore throat!). I then used this along with my own records to compile a documented chart of my weights during the last three years. I then added notations about what diet or method I was following at what time (i.e., WW, Jenny Craig, etc.) and then gave to my PCP. She then included that chart in the letter from her stating medical necessity -- it worked first time!
   — Nannette

July 2, 2003
I have Aetna PPO (not sure how HMO differs from PPO) and the best advice I can give is persistence. I was approved after my second appeal and took about a year from first consult to approval. This last appeal, I had info from my primary doctor with copies of my chart and sent those in to the surgeon's office; as much info as you can provide the better. Good luck!
   — Lisa M.




Click Here to Return
×