Aetna Criteria for coverage

[FatBoy 0]

Hello everyone ,

I'm new here , I've been reading many useful topics in this forum so thank you for sharing. I have Aetna and one of their criteria to cover the surgery is that " The member has attempted weight loss in the past without successful long-term weight reduction ", I was wondering how can I meet this requirement if I never been in Medical weight loss management program . I've been on diet all of my life, I tried Low Carb, South Beach, Atkens, liquids ..... etc. However , All of these trials were not documented by a doctor or organization like weight watcher or Jenny Craig so have any one of you had the same experience ?

Thank you so much .

:]

[Bryn 3]

One way is to have documentation from your PCP. I have Aetna as well and am finishing up my 3 month requirement. My bariatric surgeon states you don't necessarily need to try weight watchers or jenny craig type programs, but even simple documentation from you PCP stating that you and them have discussed weight loss goals, any recommendations they've given you, your weight history throughout the years, even documentation from you gyno will help. My doc also asked if i've tried certain diets on my own like south beach/atkins and i told her i have and she put that into my list of things i've tried. i also included my visit history of the gym i have been attending for the past 4 years.

hope this helps

[Was a humpty dumpty 35]

I wouldn't worry about it. Kaiser didn't even ask for any of docs I had for Weight Watchers.They just ask you if you have tried before.

[Cinderella 2]

I wouldn't worry about it..

Unfortunately, Aetna are real sticklers for the documented weight loss attempts under doctor supervision. They also require that you prove you have been overweight for at least 2 years. I got around that las one with pictures.... would never let my doctor weigh me! LOL!

Good luck with it.

[FatBoy 0]

One way is to have documentation from your PCP. I have Aetna as well and am finishing up my 3 month requirement. My bariatric surgeon states you don't necessarily need to try weight watchers or jenny craig type programs, but even simple documentation from you PCP stating that you and them have discussed weight loss goals, any recommendations they've given you, your weight history throughout the years, even documentation from you gyno will help. My doc also asked if i've tried certain diets on my own like south beach/atkins and i told her i have and she put that into my list of things i've tried. i also included my visit history of the gym i have been attending for the past 4 years.

hope this helps

Bryn,

Thanks for your input .. I'll ask my PCP to write me a letter , I'll try to get my gym visit history too .

I wouldn't worry about it. Kaiser didn't even ask for any of docs I had for Weight Watchers.They just ask you if you have tried before.

Thank you humpty dumpty, but as Cinderella mentioned, Aetna asked for losing weight attempts history !