Aetna WLS requirements

[former_vbg 198]

I spoke to a Penny (customer service Rep) today, had some more specific questions on my financial responsibilities, and also asked her where I could find information on the requirements for qualifying for this surgery.

I thought I would share this here in case anyone else might have an interest/ need.

http://www.aetna.com/healthcare-professionals/policies-guidelines/medical_clinical_policy_bulletins.html

Then, just type in the type of procedure you want information on. Type in Obesity Surgery and it will come up. You can also type in Gastric Sleeve and it will bring up pretty much the same search information.

Hope this helps others. It read a little confusing to me. I get the jist of it, but there are a few things I'm not quite clear on. We'll just have to see. I'll bring this with me when I get to see the surgeon....

[MommyTawnie 3]

With Aetna and I am speaking from eperience. They require a 3 month supervised diet with the supervision of a dietician/exercise therapist "usually dietician counts as both" and the supervision of your pcp and a pych eval. With the 6 months you are supervised by your pcp, you need 1 meeting/consult with the dietician and a pych eval. No matter if you do the 3 months or the 6 months they also require a 2 year weight history and mine requested a sleep study. Also for them to approve they require a bmi of 35 or higher with comorbidities or 40 or higher with out.. I did the 6 months charting as well as the sleep study and 2 year history and was approved within 10 days

[carameldiva 0]

Does the weight history have to be one year after another. i.e. 2008, 2009 or could you have one for 2007 and 2010 and they will accept those 2 year weight history?

I read and read the bulletin but it doesnt say the weight history has to be back to back.

Thanks I am just trying to get this stuff in order.