Aetna Weight & other stuff

[ozzy22 0]

Okay so I am looking to have my surgery at the beginning of February 2011. I have my weight records of a BMI over 40 for 2009 and 2010.

I have seen the nutritionist for the month of November and I have my December appointment scheduled.

I am currently seeing an exercise therapist once a week and also logging my daily walking at home.

I guess my questions is does Aetna want to see that you're LOSING weight during these months. Like am I supposed to get getting monthly weigh ins or anything?

Also do you think Aetna will be satisifed with me seeing an exercise therapist only one day a week?

I have just done SOOOO much stuff and I am freaking out that this won't get approved.

[peatie 4]

What exactly is your requirements?? I have Aetna and was just approved yesterday. It all depends on what your Aetna plan requires..

[lisabug 10]

Your nutritionist should weigh you. You have to maintain or lose weight during this period. Make sure you are keeping a food log too. I only saw my exercise therapist once a month. Once my paperwork was submitted, I was approved in 48 hours.

[ozzy22 0]

My nutritionist said that she would weigh me only on my first consult in Nov. Should I go to my PCP and get weighed in Dec and Jan to have it documented?

[peatie 4]

My nutritionist said that she would weigh me only on my first consult in Nov. Should I go to my PCP and get weighed in Dec and Jan to have it documented?

Again, it all depends on what your Aetna plan requires. I did not have to lose weight during the 3-month period... and in fact gained 2 lbs.

The first weigh-in is the 'official' what they go by. I did get weighed once a month (Sept-started process, Oct-PT, Nov-Nut), only saw the PT and Nut once during those months (three times total). But I went to my Dr's office to see these people, so they did chart my weight there.

What exactly does YOUR plan require?? I did not have to log all my exercise, nor see a trainer all the time. Is this something your Dr's office requires of you rather than Aetna? Can you copy/paste what Aetna requires of you? It'd be easier to then answer.

And, it took Aetna more than 2 weeks to approve me. I was banking on the 2-5 day deal everyone talks about.

[peatie 4]

Your nutritionist should weigh you. You have to maintain or lose weight during this period. Make sure you are keeping a food log too. I only saw my exercise therapist once a month. Once my paperwork was submitted, I was approved in 48 hours.

LISA! Are you sleeved???!!

[ozzy22 0]

Here is what Aetna's website says:

a. Behavior modification program supervised by qualified professional

b. consultation with a dietician or nutritionist

c. Documentation in the medical record of the member's participation 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 prepatory regimen.)

d. Reduced- calorie diet program supervised by dietician or nutritionist.

[lisabug 10]

Yes I am sleeved. Waiting to get discharged. If they don't hurry up I am going to to it myself. Lol. It has only been 3 hours since the orders were written. Overall it hasn't been as bad as I thought. The pain is tolerable. I am glad it is over. I passed my leak test yesterday. Have been on Clear Liquids since yesterday. Only get hungry occasionally and once I drink something I am fine. Have had no pain drinking as long as I am sitting up on the edge of the bed. Now for the weight loss to begin.

[peatie 4]

Yes I am sleeved. Waiting to get discharged. If they don't hurry up I am going to to it myself. Lol. It has only been 3 hours since the orders were written. Overall it hasn't been as bad as I thought. The pain is tolerable. I am glad it is over. I passed my leak test yesterday. Have been on clear liquids since yesterday. Only get hungry occasionally and once I drink something I am fine. Have had no pain drinking as long as I am sitting up on the edge of the bed. Now for the weight loss to begin.

Congrats! Wishing you a speedy recovery!!

I can tolerate the pain (with pain meds of course, hehe!) as long as I don't have nausea. How was the barium drink? I almost might be dreading that over the surgery. haha

[peatie 4]

Here is what Aetna's website says:

a. Behavior modification program supervised by qualified professional

b. consultation with a dietician or nutritionist

c. Documentation in the medical record of the member's participation 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 prepatory regimen.)

d. Reduced- calorie diet program supervised by dietician or nutritionist.

DANG! They are making you do a bunch of stuff!

a. who is the one 'handling' this behavior modification for you?

b. did they say how many you needed? Once every month?

c. To cover your butt, i'd go every month to chart a record of your progress. The exercise therapist can always follow up with their documentation to the Dr's visit.

d. sounds like this is why you're seeing the Nutr. every month, right?

[lisabug 10]

I had the same thing. I saw my pcp 3 times. My nut 4 times and physical therapist 3 times. I logged my food 3-4 days a week and exercise 3 days a week. After all was done my pcp sent my weight history. My nut wrote up a summary of everything with diet and exercise and weight for 3 months.

My friend is going thru this right now. She is doing the same thing except seeing the surgeon 3 times instead of pcp.

[ozzy22 0]

For the behavior modification they said I would need to chart everything I ate for three months. Nov, Dec, and Jan. Also they said I would need to go to two support groups and also chart my exercise.

I am going to cover my butt and get weighed once every month for three months. I have Nov taken care of so I just need Dec and Jan and a doctor to sign off on my weight.

[ozzy22 0]

lisabug, why did you see your PCP three times? Was it to get a monthly weigh in?

[lisabug 10]

Congrats! Wishing you a speedy recovery!!

I can tolerate the pain (with pain meds of course, hehe!) as long as I don't have nausea. How was the barium drink? I almost might be dreading that over the surgery. haha

I didn't have to do barium. It was this clear radioactive stuff. They told me to take it as a shot. I said I was told I can only sip. They insisted that I take it like a shit of tequila. So I did without a problem. Then I had to do a second leak test right after that. They put bright blu dye on ice cubes and I had to eat it. Then after an hour they checked my drain to see if it had any blue. No blue which means no leaks. Then I got to eat ice and drink Water. I got diluted apple juice because my blood sugar was really low. I am not diabetic, but they tested my blood sugar every 8 hours. I have no problems with drinking. No nasuea yet.

[Khy 16]

I have Aetna and am starting to try to jump through their hoops. My BMI is right at 40. If I do their 3 month diet and my BMI drops below 40.. will they deny coverage? If I do lose weight will they deny me because I didn't show that I could comply with after surgery diet restrictions?