Aetna...who has it and what did you have to do for coverage?

[TnT 0]

I know what the Aetna plan says here, but I am just not sure what it means exactly. My BMI definitely qualifies me, what has me scratching my head is the part about a six month Dr. supervised diet/exercise plan or a 3 month multidisciplanary program....what??

So, if you have Aetna, what did you do? How long did it take to get approval? Thanks!

[DougNichols 124]

Info from Dr. Nick's office told me:

Choice: - 6 month diet plan with your doctor or - 4 month diet plan with a nutritionist

Mandatory: sleep test

Mandatory: EKG

Mandatory: psychologist visit

and something else that I forgot. If your doctor's closer than the nutritionist, may be a better deal, despite the extra wait. if you make other appts while doing the diet, earliest is 4 months.

[bearwitme 1]

I have Aetna HMO. I am on the 3 month must do stuff and next week I go to my last class. Out of pocket expenses for me have been - 50.00 for each class, 100.00 for the PT, $180.0 for the Nutrtionist. One I am approved I will have to pay 300.00 for the liquid diet I will be on for the last 2 weeks before surgery. I think my hospital co-pay is 50.00. I believe that is everything except for the regular appt co-pay. I already completed my sleep study and have sleep apnea. Got the CPAP machine and did not have to pay 1 cent for it. I also did the blood work and the EKG. Not required to do the phyc. So my total out of pocket should be around 800.00. Barring any surprises that is..I have a really good policy thru my job.

[DougNichols 124]

bearwitme: what class are you referring to?

The only outstanding items I have are:

- behavior modification program supervised by a professional

- exercise regimen supervised by a professional

Edit: The two above items are part of the Dietitian's program that she puts you on.

Edited August 19, 2010 by DougNichols

[bearwitme 1]

DougNichols - Instead of the 6 month diet plan it is the 3 month diet plan throught the dr. office. It is a 3 monthy meeting with the Nutrtionist and the PT. It either this or 6 months with the reg dr.

[mmcclure 3]

I'm confused about this. I, too, have Aetna and my surgeon's office said that the three-month multidisciplinary program consists of the nutritionist, psychologist and the dietician/doctor visits in their office. Although it says in the bulletin that a supervised exercise program is required, she said that this was all we had to do and that the psychologist would monitor our exercise (we would talk with him about what we were doing as part of the behavior modification. She also said that they would keep track of everything themselves and get updates from the nutritionist and psychologist. My daughter and I are going on our third month and I do not want to find out now that we were supposed to be doing a supervised exercise program. Does anyone know exactly what is required? I've had people say all kinds of things.

[DougNichols 124]

she said that this was all we had to do and that the psychologist would monitor our exercise

My psych appointment is ONLY doing the large 500+ question test (and chatting with him). Their office said they are NOT doing the behavior mod program.

I'd call your surgeon's office to figure out where you go. You definitely want to be 100% sure.

Please let us know what they say, I'm confused too (since my surgeon's office said the nutritionist will "take care of behavior mod and exercise requirements"). And now you're saying that yours didn't. I'm taking my little happy handout to the nutritionist on my first visit, and asking her how I sign up for the behavior mod/exercise.

Worst case, I'll do monthly visits with a certified trainer at my gym, and have her document EVERYTHING.

Edited August 24, 2010 by DougNichols

[settebee 11]

I'm confused about this. I, too, have Aetna and my surgeon's office said that the three-month multidisciplinary program consists of the nutritionist, psychologist and the dietician/doctor visits in their office. Although it says in the bulletin that a supervised exercise program is required, she said that this was all we had to do and that the psychologist would monitor our exercise (we would talk with him about what we were doing as part of the behavior modification. She also said that they would keep track of everything themselves and get updates from the nutritionist and psychologist. My daughter and I are going on our third month and I do not want to find out now that we were supposed to be doing a supervised exercise program. Does anyone know exactly what is required? I've had people say all kinds of things.

All the exercise program is you talk to "fitness guy" each month about what kinds of exercise you have been doing. For example, month one I walked 2 days a week for a mile, month 2 I picked up swimming a few days a week since the weather permits and still walked, third month walked, swam some and trying workout dvds. They just want to see you are making exercise a priority as well in your journey of weight loss. Nothing scary, just a few questions on what you are doing different. :001_tt2: I hope that helps.

[lil red raider 5]

I did 3 mos with a dietician, 1 nutrtional eval, pt, and met with the doctor each visit. I did one psych eval and was approved. My surgeon's office had the dietician, doctor and pt all in one. So I only had to pay one copay. I have Aetna Select.

[mrspalmour 0]

My surgeon's office has it all maped out. I am seeing their in office pcp who discusses exercise and has put me on weight loss medication. I have my apt set up with the psych and my three nutritionist visits. My last visit to have the three month diet and exercise program wrapped up is November 18. Im hoping to have surgery scheduled by December 30. I know this is all a pain but I can tell you I work for UnitedHealthcare and review the medical plans for obesity surgeries and this criteria is not bad and we are all blessed to even have the option to have insurance coverage for this surgery. UnitedHeathcare has made obesity surgery excluded for their employees no matter how obese they are. I am so so so stoked to have the option not im happy to jump through some hoops.

Michelle