Question:
What should I do next, got denied by Aetna HMO?

Just got news from my PCP that I am denied with Aetna. Aetna wants 6 month supervised diet. I already have 6 month supervised diet with my PCP but Aetna wants it to be with Nutritionist. What should I do? Thank you    — JuliaV (posted on March 4, 2004)

March 4, 2004
Last year I had Aetna insurance. I went right to them and had them find me a nutritionist in network.
   — Sue C.

March 4, 2004
Appeal but in the mean time..go to a nutritionalist and get started. I also saw a behavioral therapist for 6months. It is soooo worth the wait.Take this time to get in the best possible mental and physical condition and best of luck to you.
   — Kathy S.

March 4, 2004
Go with an appeal. I have Aetna HMO and they approved me in a week. I had no supervised diets...just a few talks with my PCP on nutrition. If your PCP wrote a letter, check on how they wrote it. Definately appeal though because sometimes it seems what kind of mood the person who reviews it is in.
   — emilyfink

March 4, 2004
Contact Obesitylaw.com, Walter Linstrom. That is what I did. I went through the exact thing that you are! He'll write an appeal letter that they can't refuse!
   — Jeanne S.

March 4, 2004
I have Aetna HMO and was denied the first time. I did my 6 month supervised diet, re-submitted and was denied again because I didn't consult a nutritionist. However, my original denial letter didn't say anything about a nutritionist, so I spoke with the doctor that denied me and he said if I could fax him the original denial, he would change his decision. He changed his mind. Mind you, this wasn't without a battle and talking to several people at the insurance company before I talked to the doctor. Julie
   — Julie S.

March 5, 2004
Your diet doesn't have to be supervised by a nutritionist, you just need to see one and make sure your PCP gets a copy of the nutritionist report and notes it in your medical records that you seen one. You also need to be "prescribed" exercise (have pcp put something in your records regarding exercise). In certain situations, a psych eval is also required. Here is a link to Aetna's current requirements. They seem to change every few months or so. http://www.aetna.com/cpb/data/CPBA0157.html Good Luck
   — Carolyn M.

March 5, 2004
Hi there, I had exactly the same problem with Aetna, and my PCP didn't count for supervised diet. I talked with a customer service rep @ Aetna who told me that Weight Watchers counted, so I joined. When Aetna wanted to deny me again, I referenced this call and the name and date of the person I talked to, and then sent in copies of my W.W. book to show I had been going and working the program. I lost a whopping 12 lbs. over 6 months, but it did get them to overturn their first denial. So check on that to see if it would qualify. I found the only thing I could do was to comply with every detail they wanted. I also scheduled a monthly visit with my PCP and had her code it as obesity related. Aetna wanted those visits for 1 year, so if you already have 6 months with yours, continue to go monthly for the next 6 as well as to W.W. or to a nutritionist. They are looking for ways to deny us, so I was diligent in following all their rules. It worked! Had my surgery almost 3 weeks ago after fighting with them for over a year. It was worth it. Good luck and keep fighting. They really hope we will go away after they throw up so many roadblocks. Hope that helps some. Pat F.
   — Patricia F.

March 5, 2004
Try emailing gary. [email protected] his advice is free. You may not even have to hire anyone.
   — superellen