Aetna 3 month program question

[stockerx2 1]

For those of you that have Aetna and used the 3 month Multidisciplinary surgical preparatory regimen, what exactly did you end up submitting? The clinical policy bulletin states the following items must be done:

1. Behavior modification program supervised by qualified professional; and
2. Consultation with a dietician or nutritionist; and
3. Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit. (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.); and
4. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
5. Program must have a substantial face-to-face component (must not be entirely delivered remotely); and
6. Reduced-calorie diet program supervised by dietician or nutritionist.

The nutritionist is having me document 90 days of diet and once I have that, they will submit it. I'm fine with doing the documentation, because it's important to track it and I'll need to do it in the future. That said, I don't see in the list of "to dos" where a diet log is required for submission.

In the end, I know I'll get the surgery - but I was hoping that we could use the date of my physician consult vs the date that I first met with the nutritionist for the calculation of the 90 days. There is about a 3 week difference! If I would have known, I would have started to document my diet earlier! I've got everything else completed and just have to finish this component!

Oh...the waiting begins...

[Atsirc 10]

For those of you that have Aetna and used the 3 month Multidisciplinary surgical preparatory regimen, what exactly did you end up submitting? The clinical policy bulletin states the following items must be done:

1. Behavior modification program supervised by qualified professional; and
2. Consultation with a dietician or nutritionist; and
3. Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit. (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.); and
4. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
5. Program must have a substantial face-to-face component (must not be entirely delivered remotely); and
6. Reduced-calorie diet program supervised by dietician or nutritionist.

The nutritionist is having me document 90 days of diet and once I have that, they will submit it. I'm fine with doing the documentation, because it's important to track it and I'll need to do it in the future. That said, I don't see in the list of "to dos" where a diet log is required for submission.

In the end, I know I'll get the surgery - but I was hoping that we could use the date of my physician consult vs the date that I first met with the nutritionist for the calculation of the 90 days. There is about a 3 week difference! If I would have known, I would have started to document my diet earlier! I've got everything else completed and just have to finish this component!

Oh...the waiting begins...

I had the same question about a month ago! I went through the 3 month program. What I did was see my primary care doctor and nutritionist once a month for three months. My pcp filled out a form that went over my diet for the month, my exercise, and my goals for the next month. The nutritionist and I would talk about the month (food, exercise, goals, ect.). When I saw both they documented my weight, and every month I lost (always between 1-4 lbs). After I completed my 3 months and done my psyc. eval and the labs the paperwork was submitted. The day after it was submitted the lap band clinic called me back to get any documentation going back 2 years that recorded my weight. Thankfully I remembered a clinic I went to about 4 years ago. After those records were faxed over I was approved within 2 days! If you have ANY other questions please feel free to email me: crista07@gmail.com I know I was a total wreck not knowing if what I had done was going to get me approved or if I would have to wait another 3 months! Good Luck!