Aetna, Richmond, Va- 3 Month Process Help!!!!!

[enuff_is_enuff 126]

I am starting, (again), my 3 month process for Aetna with VCU Medical Center here in Richmond. For some reason, the insurance coordinator for my surgeon does not have a wealth of information.

For those of you that have been approved by Aetna on the 3 month process, how did your process go from start to finish?

As i explained to the insurance coordinator, I want to have all my ducks in a row the FIRST time I submit my information to show that I am really putting forth the effort and that it would not be a waste of time of money to allow me to have the surgery. I became soooo frustrated at work today and even briefly gave up.. For those of you who have Aetna and call to inquire about a clinical bullitin, ask to speak to a nurse. They are the only ones that can discuss the bullitin in detail with you.

Here is what I have completed so far.

1. Met with the surgeon, dietician, and nurse practicioner all in one visit ( 3 + hours!)

2. Made an appt to continue with the dietician

3. Made an appt with the psychologist at the hospital.

4. Now I am just waiting for the appts.

The start date for all of this was August 22nd. Would my 3 month period be from this date or when I actually meet with the nutritionist?

Here are a few other questions that I have.. Thank you in advance for any information you may provide. It is much appreciated.

3 month process?

How often did you meet with your surgeon?

Did you have to see your pcp, if so, how often and how was it documented?

Did you see a separate physician or specialists for behav. mod? If so, what type?

How was your exercise regimen documented?....

[Sojourner 2,446]

I am starting, (again), my 3 month process for Aetna with VCU Medical Center here in Richmond. For some reason, the insurance coordinator for my surgeon does not have a wealth of information.

For those of you that have been approved by Aetna on the 3 month process, how did your process go from start to finish?

As i explained to the insurance coordinator, I want to have all my ducks in a row the FIRST time I submit my information to show that I am really putting forth the effort and that it would not be a waste of time of money to allow me to have the surgery. I became soooo frustrated at work today and even briefly gave up.. For those of you who have Aetna and call to inquire about a clinical bullitin, ask to speak to a nurse. They are the only ones that can discuss the bullitin in detail with you.

Here is what I have completed so far.

1. Met with the surgeon, dietician, and nurse practicioner all in one visit ( 3 + hours!)

2. Made an appt to continue with the dietician

3. Made an appt with the psychologist at the hospital.

4. Now I am just waiting for the appts.

The start date for all of this was August 22nd. Would my 3 month period be from this date or when I actually meet with the nutritionist?

Here are a few other questions that I have.. Thank you in advance for any information you may provide. It is much appreciated.

3 month process?

How often did you meet with your surgeon?

Did you have to see your pcp, if so, how often and how was it documented?

Did you see a separate physician or specialists for behav. mod? If so, what type?

How was your exercise regimen documented?....

Aetna covered the cost of my surgery...however I had to complete a 6 month medically supervised diet which was supervised by my PCP, who also wrote my letter of medical necessity. I met with him monthly, and did not have a "prescribed exercise regimen" from him. He documented my compliance with this requirement in his medical notes required at every appointment. My exercise was not required to be documented.

I was not required to see any behavioral health professional for behavior modification...only had to meet with her one time for my psych eval.

I met with the surgeon for the first time only 1 week prior to my surgery date for my pre op appointment...the insurance coordinator at the surgeon's office made certain that all of the required documentation was available to submit everything together. I also had to submit 3 years worth of medical records to document my weight history.

I'd be speaking with the insurance coordinator at your surgeon's office; they seem to be quite knowledgeable about the approval process. My surgeon's coordinator and I spoke on the phone several times, and she told me prior to her submitting everything that she had no doubt that Aetna would approve my surgery.

Hope this information helps...best wishes for a smooth approval process!

[enuff_is_enuff 126]

Thanks for the information. The person I spoke with at his office was the insurance coordinator. She said she is not familiar with the three month process and that most of her patients are declined when they try that option. She also told me Aetna doesnt tell why they declined which is not true as i spoke with Aetna shortly thereafter. I did overlook the fact of the wealth of information this site offers and have now calmed down about it. Its just hard when you want something so bad and things dont seem to be going in that direction. If i have to switch over to the 6 month process, I will be ok. Thanks again :-)

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