Question:
Has anyone had surgery with aetna ins since they revised their plan in April 2005 .

aetna always required a 6 months physician supervised diet. Now they will cover 3 months multidicplinary program.    — Water Baby (posted on July 12, 2005)

July 12, 2005
I just submitted my paperwork a few days ago using the 3 months multidiciplicany program. I will let you know what comes of it.
   — *Malena* M.

July 12, 2005
What is the 3 month multidisciplinary program?
   — Sharon2004

July 12, 2005
This is what is required for the 3 month program. I have heard from some people that Aetna has declined them, although I have also talked to a few people who have been approved. My doctors office has never had anyone approved using this... Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions: Consultation with a dietician or nutritionist; and Reduced-calorie diet program supervised by dietician or nutritionist; and Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and Behavior modification program supervised by qualified professional; and Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.)
   — *Malena* M.

July 14, 2005
I was just approved last week from Aetna. I am working with a great bariatric program in Ohio that really makes sure you have everything you neeed. You MUST have 5 years weight history on office notes (not in a letter), 3 months multidisiplinary weight loss program or 6 months physican supervised weight loss and a letter of medical necessity. I had everything in order when my surgeon's office submitted the paperwork and I had approval in about a week!! I was shocked. I would be happy to answer any questions, feel free to e-mail me. Shellie
   — Shelld

July 15, 2005
I just got approval from Aetna yesterday. I was told by Aetna that it is actually much easier to get approved if you follow the "older" criteria then the 3 month plan. Aetna actually told me to go on their website and do a search for obesity surgery and the first result will give you a complete discription of exactly what Aetna wants if there is either no exclusion or an exclusion stating med. necessary. I took that list to my family physician (thats who did my 6 mo diet) and he followed that. I only sent in my six month diet, a letter of med. necessity from my family dr. which included the 5 year obesity clause (no documentation), a letter from my ortho. dr., and there was NO problem. Follow what Aetna gives you and you should be fine.
   — Mandy S.