Question:
I NEED TO APPEAL AETNA BECAUSE THEY ARE SAYING I DO NOT HAVE THE REQUIRED 6 MONTH

OF NUTRITION SUPERVISED DIET    — joe G. (posted on April 20, 2005)

April 20, 2005
Contact Gary Viscio at http://obesitylawyers.com/ He is appealing my 12 month diet history denial with BCBS. He felt confident enough to take my case so I'd give him a call or email him.
   — maxsmom77

April 20, 2005
I hadve Aetna and they said the same thing to me. I did my 6 months and it went by so fast. I went to my PCP once a month and he wrote down that I was on a 1200 calorie diet and that I walked for 30 min every day (wich I did). He updated it every month when I went in. I only lost about 10 lbs but that is what they wanted to see. When they first denied me I thought that it was the end of the world but after I did what they wanted it only took them about 3 days to get me approved. I do know that here in Texas that it is one of the majior req. I had diet history but it was not 6 cons. months. I hope this helps you out. Jaime Dr. Naaman TX 12-27-04 278-210
   — jaime

April 20, 2005
Joe... My insurance company is Aetna, also. They denied me for the same reason but I appealed it and eleven days later the director of the medical review board overturned the decision and I had my Lap RNY surgery March 18, 2005. Just 4 weeks ago. Don't give up. Fight them. It will work for you. Good Luck in your future WLS.
   — LindaKM

April 20, 2005
yes, you can appeal, you can hire an attorney, but it might be cheaper and faster to just do the 6 month diet,If you get started now you could be a loser before halloween!
   — **willow**

April 21, 2005
I dont think hiring an attorney is necessary/What my pcp did was write an appeal letter saying that I had modified my diet to 3meals a day. and I had been walking at home or atthe gym 30-45 min a day and if you have attended any group sessions or wls support meetings you need to list that and that you are still attending . and she also listed my existing health conditions such as hypertension, back pain etc.along with your current bmi and any conditions that you may be at risk in having as a result of the weight. thats all we did and they approved within 15 days of my appeal
   — Bobbie R.

April 21, 2005
you need to quoat them thier new cbt 0157 which states in part,4. Member must meet either criterion a (physician-supervised nutrition and exercise program)" OR " criterion b (multidisciplinary surgical preparatory regimen): THE KEY WORD IS OR/EITHER, NOT BOTH, THIS UPDATE WAS ISSUE 4/19/05 THE DIET HISTORY IS OUT, ITS THIER RULES,MAKE PLAY BY EM.
   — walter A.