Aetna Supervised 3 or 6 month program

[MsSonja 0]

I have Aetna and my experience went fairly well. I had 1st consultation with surgeon in March, was approved in June with every piece of documentation needed; had surgery July 1.

When the plan says monthly, they mean once a month, not 30 days. You can have an appt Oct 5, Nov 27 and Dec 3. but you can't have Oct 30, Nov 30 and Jan 1. That 2 day difference will cause you to get denied!!

I needed 5 year documented weight charts (go with your highest weight and request med records). They want to see the yo-yo. If you have WW weight card, use it!

Even though you can 3 months with physician (& nutritionist) or 6 months alone, it's best to do the 3 mos because the surgeon's office will make sure you've got what you need, if one thing is missing, you're not getting approved. Not even with an appeal.

If your surgeon has a nutritionist, go with them instead of your own. They work as a team.

The plan requires certain things. If your surgeon requires more, if you don't think it's necessary, such as a sleep study, discuss it. My surgeon requested Iron fusion treatment (not covered and I wasn't paying out of pocket).

The success of surgery is dependent on the tests and findings. This is why your surgeon requires additional tests and studies.

Furthermore, the plan requires a certain BMI. Higher usually aproved, but lower requires that you suffer from co-morbid conditions, even snoring counts. If you don't have any pain or issues, you can be denied.

I don't work for the insurance company, but I am the benefits administrator for my employer. I KNOW some things, but I don't know everything or every plan. Drop me a line if you need some insight. ~~Sonja

[peatie 4]

I have Aetna and my experience went fairly well. I had 1st consultation with surgeon in March, was approved in June with every piece of documentation needed; had surgery July 1.

I needed 5 year documented weight charts (go with your highest weight and request med records). They want to see the yo-yo. If you have WW weight card, use it!

~~Sonja

Why 5 years?

Their website only says For adults age 18 years or older, presence of severe obesity that has persisted for at least the last 2 years (24 months) .

Why didn't only two years matter?

[MsSonja 0]

I know Aetna has recently updated their policy bulletin, as the VSG was just covered as of June 2010. It may now be 2 years for weight history as well. And that's a good thing.

[ozzy22 0]

What did yall do for the supervised exercise program? I need to go I guess once every three months to a supervised exercise regimen by an exercise therapist or a trained professional.

Just wondering what yall did for this??

[DougNichols 124]

Nothing. My nutritionist qualifies for my "supervised exercise program", and all she did was ask me if I was working out.

What did yall do for the supervised exercise program? I need to go I guess once every three months to a supervised exercise regimen by an exercise therapist or a trained professional.

Just wondering what yall did for this??

[ozzy22 0]

hmm that's interesting. I guess every insurance policy is differnet. Mine said I must complete 3 months with an exercise therapist. I could either join a yoga class, hire a personal trainer, or join a Water areobics class.

[Jonnie 0]

I have Aetna and my experience went fairly well. I had 1st consultation with surgeon in March, was approved in June with every piece of documentation needed; had surgery July 1.

When the plan says monthly, they mean once a month, not 30 days. You can have an appt Oct 5, Nov 27 and Dec 3. but you can't have Oct 30, Nov 30 and Jan 1. That 2 day difference will cause you to get denied!!

I needed 5 year documented weight charts (go with your highest weight and request med records). They want to see the yo-yo. If you have WW weight card, use it!

Even though you can 3 months with physician (& nutritionist) or 6 months alone, it's best to do the 3 mos because the surgeon's office will make sure you've got what you need, if one thing is missing, you're not getting approved. Not even with an appeal.

If your surgeon has a nutritionist, go with them instead of your own. They work as a team.

The plan requires certain things. If your surgeon requires more, if you don't think it's necessary, such as a sleep study, discuss it. My surgeon requested Iron fusion treatment (not covered and I wasn't paying out of pocket).

The success of surgery is dependent on the tests and findings. This is why your surgeon requires additional tests and studies.

Furthermore, the plan requires a certain BMI. Higher usually aproved, but lower requires that you suffer from co-morbid conditions, even snoring counts. If you don't have any pain or issues, you can be denied.

I don't work for the insurance company, but I am the benefits administrator for my employer. I KNOW some things, but I don't know everything or every plan. Drop me a line if you need some insight. ~~Sonja

This bit of info really helped me! My info is going to be submitted tomorrow and I'm a nervous wreck!