Atnea & 6 Month Supervised Diet

[Krystle Austin 14]

I have talked to my insurence at least 15 times to confirm coverage and reviewed my plan discription. I had a feeling that the insurence would have more then just a BMI requirement that they had been telling me and my plan discription stated. So i wrote the insurence company and got this reply....

Dear Mrs. Austin;

We are in receipt of your request regarding Lapband Surgery 43770 and

what information is needed to review for a predetermination. The folowing

information would be needed from the surgeon;

* A Letter of Medical Necessity(LOMN) with height, weight, BMI, comorbidities,

medications used to treat the co-morbid conditions,

documentation of a 6 month(180 day) supervised diet occuring

within the past 2 years, the nutrition evaluation, a favorable

psychiatric evaluation and any clearances the surgeon feels are

required based upon the severity of the patient's co-morbid

conditions.

The request needs to come from the surgeon and not your Primary Care

Physician. Your Primary Care Physician can write a note and/or supervise

the 6 month diet but the surgeon must request the surgery.

A cover sheet needs to be included also, which states exactly what

services are being requested along with CPT Codes and Diagnosis Codes.

I hope this answers your questions. Per your plan, any services you

receive are subject to the Pre Existing Conditions of your Plan through

April 13, 2013.

Can you please help me deside if i will need a 6 month consective diet or if my doctors previous attempts with medications and diet on and off will work... The insurence is no help at all..... Also do i have to have comorbidities? I am boarderline diabetic..... I have high cholestorol...

I am just so annoyed and confused & the insurence is no help they just say sent the information and the predetermonation will be approved or not... then ill know what i need. I have asked for a detailed description and they state they dont have it and i cant speak to predetermination.

[Maddysgram 6,159]

I have Aetna and that is exactly what I had to do. If you have 6mths of consecutive supervised diet with PCP they will except that. I did not and had to start at day one(just finished 6mths). My bariatric surgeon did handle everything. They stayed in contact with PCP. Psych Eval sent report to surgeon. Right now surgeon just sent all of above requirements to insurance for approval. Now I wait!!!!

This is a good time for you to educate yourself on the Lapband. It's not a magic cure to weight loss, but a tool that has to be used properly.

Good luck on your journey and post often!

[Krystle Austin 14]

I have been through the lap band process before i just lost my job and had to start over. I have done weight watchers does that count if i saw my dr?

[Maddysgram 6,159]

I have read on here that WW does count if you have documentation. As long as it was consecutively.

I almost had to start over because me Dr. went on vacation and I was going to miss an appt in July. My bariatric office caught it at the last minute and I was able to see a Doctor filling in for him. I would have been really ripped if I had to start over.

[Sojourner 2,446]

Aetna offers many different policies...and I guess that the requirements for approval for WLS differ also...

My PCP provided the medical supervision for my 6 month diet, and then "held the approval window open" for me for an additional 11 months while I had several unanticipated medical events present which needed to be resolved before my paperwork could be submitted to Aetna for their approval.

I had Aetna's surgery approval prior to meeting with my bariatric surgeon for the first time...and while my PCP's office submitted the letter of medical necessity and the required 3 years of medical records in addition to the 6 months diet documentation directly to Aetna, the insurance coordinator at my surgeon's office interfaced directly with Aetna, and was the one to notify me that approval from Aetna had been received.

Good luck...and remember patience helps...

[brandyrn73 13]

New here..

I've completed my entire "work up" for the band at Ohio State and was told by the coordinator that my file will be sent to Aetna for approval...I'm confused by all the talk of the 6 month supervised diet...my coordinator has NEVER mentioned this to me! I had to take a 3 month course on healthy living, eating well, etc etc but that's it...no 6 month diet.

I really hope they aren't missing something here! My BMI is 38+ and my co-morbids are high cholesteral, severe hyopthyroidism, depression and GERD. I'm nervous enough as it is that I'm not going to approved! Thoughts anyone?

[ChicagoRose 650]

I have Aetna and that is exactly what I had to do. If you have 6mths of consecutive supervised diet with PCP they will except that. I did not and had to start at day one(just finished 6mths). My bariatric surgeon did handle everything. They stayed in contact with PCP. Psych Eval sent report to surgeon. Right now surgeon just sent all of above requirements to insurance for approval. Now I wait!!!!

This is a good time for you to educate yourself on the Lapband. It's not a magic cure to weight loss, but a tool that has to be used properly.

Good luck on your journey and post often!

Lucky.

Looks like I am on the same time-table as you (6 months in) but I cannot even go to the surgery center until this 6 month diet is over! I am anxious!

[RhondaMarie 67]

New here..

I've completed my entire "work up" for the band at Ohio State and was told by the coordinator that my file will be sent to Aetna for approval...I'm confused by all the talk of the 6 month supervised diet...my coordinator has NEVER mentioned this to me! I had to take a 3 month course on healthy living' date=' eating well, etc etc but that's it...no 6 month diet.

I really hope they aren't missing something here! My BMI is 38+ and my co-morbids are high cholesteral, severe hyopthyroidism, depression and GERD. I'm nervous enough as it is that I'm not going to approved! Thoughts anyone?[/quote']

Different plans/payors have different requirements. Your plan may be one that doesn't require it.

The 6 month wait I had loomed out like a crazy delay. I, now, am very thankful for it. It gave me time to space out everything else LEARN about what I was planning to do. The other big difference (for me) was having to weigh in & be held accountable. I understand people who say if I could diet I would... but having a goal in site kept me on point longer than I ever would have alone.

If you don't have to wait 6 months, I would still give yourself a little time to adopt the lapband "mindset."

[Sarah75 67]

My 6 month diet that was mandatory by Aenta just consisted of me going to my surgeons office once a month to weigh in...the coordinator put everything together for me I just had to get the 3 standard clearances and have my medical records that showed my weight over the last 2 years on it..never had to deal with my PCP...and I was approved in less then a week once it was all submitted