Weight Loss Center Clueless ?

[LomoMandy 0]

I was scheduled for a Endoscopy today and have been on

pre-op diet for two weeks yesterday WLC of America in Beverly Hills canceled my appointment. They claimed that AETNA insurance changed and they needed to satrt over again with the process. Also now I would need their nutriion program for 90 days. Should I seek another Doctor? Have others had a similar experiences? Am I being to critical?

[HappyDay 0]

That sounds very disappointing!! My insurance requires 6 months nutrition classes so it's been a long wait. My surgery isn't until April. You should be sure that your doc's office is current with all of the insurance requirements. Seems to me that they should have been aware of the changes. Good luck to you.

As far as looking for a new doc.....I suppose that would depend on whether you like him or not - I would just be sure that they follow through with the insurance requirements more closely.

[adagray 1]

Aetna has always required a nutrition program. There were some very minor changes made to their Clinical Policy Bulletin for Obesity surgery on 12/18/09. The only changes were:

"This CPB has been revised to state that the StomaphyX device for bariatric surgery repair or revision is considered experimental and investigational. This CPB is revised to state that a multidisciplinary preoperative surgical preparatory regimen or a physician-supervised nutrition and exercise program must have a substantial face-to-face component. This CPB is revised to state that the preoperative surgical preparatory regimen must be for three consecutive months, and must be provided proximate (within 6 months) prior to the date of surgery."

The full CPB can be found at Obesity Surgery

I highly recommend for anyone considering WLS to thoroughly review your insurance company's policy yourself. Its important to verify that you meet the requirements, but also to argue your case if it goes to appeal. I had to do two appeals w/Aetna to get approved. The way I was approved was by arguing that I met the intention of the requirement as stated in the background. So, it helps to read the whole thing, not just the summary.

Edited February 14, 2010 by adagray

[btrieger 21]

I highly recommend for anyone considering WLS to thoroughly review your insurance company's policy yourself. Its important to verify that you meet the requirements, but also to argue your case if it goes to appeal. I had to do two appeals w/Aetna to get approved. The way I was approved was by arguing that I met the intention of the requirement as stated in the background. So, it helps to read the whole thing, not just the summary.

Don't just review your policy, call the insurance company and ask them.

I've called Aetna a half dozen times in the last 2 months to find out what was holding up my approval. It turns out that the paper work wasn't submitted when the surgeon's office says it was. Aetna approved 5 days after submission.