Question:
Anyone with recent experience with Aetna QPOS?
I was just wondering if anyone could share their experience with me about getting approved through Aetna QPOS? I am waiting for my cardaic clearance, then we will submit for the first time. There is a clinical policy bulletin that states I need a 'multidisciplinary' program. When I called to verify, they said that the providers do not need to be in one office. However, my doc's office said they do?? How many of you have heard of a psychologist, registered dietician and internist in one office? Not here in NJ anyway! Thanks for any info! — cathy1966anne (posted on June 2, 2005)
June 2, 2005
Have you asked your wls doctor? I have Aetna HMO, and I am doing the 3
month surgical regimin now. When I went to my wls dr, the nutritionist
there gave me information on several places in my area. Look up information
for wellness centers in your area. If not, call around and talk to
nutritionists, maybe they can help.
— bawana
June 2, 2005
Cathy,
The best person to speak to is the Aetna Case Manager. I went through
the same routine. They did not have to be all in the same office. Your
PCP or WLS surgeon can handle the bi-monthly weigh-ins with basic vitals
after you meet with a nutritionist and get a basic low calorie, low fat
diet. Your WLS surgeon should put all the results of all the tests and the
documentation of your weigh-ins together and mail it to AETNA after 3
months. Approval is quick after that, it goes by fast. Good Luck.
— pammatria
June 2, 2005
Cathy,
I forgot to address your concerns regarding the cardiologist,
pulmonalogist, psychiatrist, gastroenterologist(for the EGD). No, they do
not have to be all in the same office. Call your AETNA case manager to
verify, but I am quite sure. Mine certainly weren't. Yes, I have AETNA
POS.
— pammatria
June 6, 2005
The best thing to do is to check with your Aetna rep, then make sure that
all the docs that you go to are accepted by Aetna. I just went through the
process and I have QPOS. Just be sure that you get everything in and make
sure that you do it fast, I was told by my Aetna rep that in certain cases
they are not covering the surgery anymore, calling it cosmetic rather than
life saving.
— dreamy6501
June 11, 2005
Cathy,
Sorry you are going thru this. Aetna seems to be the hardest insurance
"nut" to crack right now. I went to the 3 providers that were
recommended to me by my Bariatric Surgeon. That is all that I could do.
There is NO office with those 3 people in it. Not one that I could find
anyway. My surgeon wrote a letter, as did all of the other 3 recommended me
for the surgery as MEDICALLY NECESSARY. It HAS to say that. Also, Aetna
requires an EXTENSIVE history in Diet and excersise that shows that you
have tried to get the weight off by yourself. You MUST have at LEAST 1 year
of proof of this. I got my primary physician to write a letter concerning
this and sent in my ENTIRE medical chart for the last 8 years.
It is a tedious process, but if you do it throughly and included
everything, they will have to take you!!
Good luck Sweetie!
Ans
— OmahaAns
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