Question:
AETNA wants a DOCUMENTED 5YR HISTORY of diets I've been on.
I took son to Dr today, and in leaving PCP says he's received a letter recently asking for 5 yr documented diet history. He of course doesn't have this. He asked what he should do. I've had a feeling in the last 2-3 days that Aetna would try to pull something like this, but I was still shocked none the less. I told him to tell the truth, and that I would just have to appeal. He knows I've been trying to get this approved for sev yrs, and will do what is necessary to help me in this. Since being at home and discussing with hubby, I've thought about taking PCP my diet hx that shows I've been on Weight Watchers 2x, Xenadrine, Lo carb, and Lo calorie for the last 5 yrs. This is not documented of course. And I've also thought about asking him to just submit the 2 different letters AGAIN that he's already written. I'm not sure which way if either of these is the best way to go. Please Amos family, GIVE ME SOME INPUT BEFORE MON AM. I want him to send this info in ASAP, but I want to get back with the PCP Mon am before he sends anything in. Any help will be GREATLY appreciated. Thanks in advance!!! — bufordslipstick (posted on October 19, 2003)
October 18, 2003
Are you sure you didnt misunderstand, I had my surgery a month ago with
Aetna and they wanted PROOF that I had been moribidly obese for 5 years and
documented diet for 6 months..Best ofluck to you, all I needed was old
medical records that happened to mention my weight. Was good enough
— Kathy S.
October 19, 2003
Rebecca - I agree with the previous poster - I have gone over all the Aetna
requirements with a fine tooth comb and they require a 5 year WEIGHT
history - i.e. Physician records showing your recorded weight eadch year
for the past 5 years, NOT a five year history of documented DIETS. They do
require a 6 month Dr. supervised diet within the past 2 years. I read
through some of your profile and I'm amazed you've not been approved yet.
Your BMI is high enough, you have obstructive sleep apnea and used a CPAP
machine for YEARS! and you have five physicians in different specialties
backing you up saying you need this surgery! I feel so bad for you - what
a time you've had! From your PCP to your preacher to your co-workers not
wanting a fan on in the summer in a metal building!!!! If you've not done
so, I'd go to the Aetna Navigator website, do an alphabetical search to
find the clinical policy bulletin for "Obesity - surgical
treatment" and read their requirements. Print a copy for your PCP and
have him give you (or have his office submit to Aetna) your recorded weight
for the past five years. You might even write an appeal letter to Aetna,
stating some of the things that are in your profile, like your problems on
the job with working in the heat with no fan, how you're on your SECOND
CPAP machine, inability to exercise because of SOB and joint pain, etc. I
have Aetna, too, and am trying to get approved, so I know what you're going
through. Good luck!!!!
— Carly H.
October 19, 2003
So sorry to hear of all your hassle in trying to get approved! Unjust!!!
Aetna approved me in less than 24 hrs, of course this was in Feb of this
year. Things may have changed since then, but I have read of several on
this site, that also have Aetna and they got approved rather quickly too.
I never had to show a 5 yr record of supervised dieting. My PCP did say he
had me on Merida and I couldn't take it, because of rapid heart beat. Also,
on the letter all the diets I have been on for 5-6 years previously, but
not documented.
I did have a letter from foot specialist and therapist, besides PCP and
surgeon.
My main factor was my blood pressure was very high and would not come down
with medications given. Next was problems with my ankles. Of course, rashes
were a constant thing. Trouble sleeping and snoring, but noting like you.
Like the post above stated.....With all your health problems resulting from
your obesity....I'm surprised you haven't been approved as of yet!
You certainly have more than one Dr agreeing you need surgery. Maybe, your
letters have not been stated as should be.
Good Luck......I hope and pray you will be approved and your life can
become healthy once more, as mine has!
Lap RNY 2/11/03 250/150/135
— Hazel S.
October 19, 2003
I have Aetna Insurance also. I had to show a 5 year history of being obese
and at least 1 supervised diet program that lasted 6 months in the past 2
years. The only one I had was with Weight Watchers. I took that to my PCP
and he incorporated that into his letter to Aetna. I also wrote my own
letter and had my surgeons staff fax it along with a copy of the Weight
Watchers profile and my medical records for the past 5 years to Aetna. I
weighed 240#, 5'2" tall, BMI of 44. The only co-morbity I had was
HBP. I had a letter of approval within 2 weeks. I am now 4 1/2 weeks
post-op and have lost 34#. I would be glad to mail you a copy of my letter
and also the one my PCP wrote. Send me an E-Mail with your mailing address
and I'll have it in the mail the same day. Lots of luck, Rita
— Rita V.
October 19, 2003
YOU WILL HAVE TO DOCUMENT 5 YRS DIET BUT IF NO DOCUMENTATION DR.SHOULD PUT
YOU ON 6 MTHS DIET DOCUMENTED BY HIM.I AM ON ANOTHER INSURANCE & THIS
IS WHAT I HAD TO DO BUT ALSO MY FRIEND ON AETNA HAD SAME PROBLEM &
FINALLY GOT APPROVED...GOOD LUCK****P.S.- IT TOOK ME 2 YRS TO GET APPROVED
BUT I DID IT & I'M NOW DOWN 100 LBS...
— BLSLIM77
October 19, 2003
Maybe I misunderstood the PCP, but I also looked in the library and there
are sev people in there from 1/1/03 that Aetna has wanted 5 YR DOCUMENTED
DIET HX from. I sent in a 10 pg letter stating why I need this surgery, and
have been on the diet for 5 mo. I am thinking of sending in a paper with
highlighted titles of Age, Former diets, Doc medically supervised diet
histry, Reasons for needing surgery, and Conditions that will be alleviated
therefore saving Aetna $. I would write these out properly of course and
highlight them. Then I could send in original 2 letters PCP wrote, 10 pg
letter I send prev, PCP medical records, and Nutritionists letter and
highlight all info pertaining to these titles of these in different colored
inks (dumbing down info), and then overnight it with a signature required
to the bariatric Dr that sent PCP letter req additional info. This is how
someone on here got approved without having to go thru an "official
appeal process" Thanks for all of your support and keep me in your
prayers. If I can't get this ready by tomorrow, I will ask PCP to give me a
few days to get this together.
— bufordslipstick
October 19, 2003
Yes, I had my surgery five months ago and I had to show proof of 5 years
history of morbid obesity and 6 month doctor supervised diet. I think your
surgeon read it wrong or you misunderstood in the translation of the
letter. Go to Aetna's website and see the requirements. Most insurance
companies are requesting the same kind of info before approval.
— Michelle A.
October 21, 2003
Marji, I saw your previous info under "Aetna" in the library and
this is basicly what I used. Thanks for all of the info. If this doesn't
work, I'll use the great additional you've provided. Even if I am denied,
this time going thru this process is a breeze compared to when I did it
myself not knowing about this website. It's the WAITING that's he**!!
— bufordslipstick
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