Aetna 3 Months Question

[FatBoy 0]

Hello everyone,

I have Aetna and now I'm doing the 3 months multidisciplinary program. I know that I have to see my doc and nutritionist once a month at least . I travel alot bcz of my work so my question is , Do I have to see them one time during the 30 days or its ok if the gap between the visits exceeds 30 days ? for example I visit my doc early January, Late Febuary and mid March ? will that work for Aetna ?

Thank you

[DougNichols 124]

You need 4 visits in 90 days. Days in between don't matter. I think mine was like 20 days, then 35 days, etc, and I got approved no problemo.

[FatBoy 0]

You need 4 visits in 90 days. Days in between don't matter. I think mine was like 20 days, then 35 days, etc, and I got approved no problemo.

Hey DougNichols,

Thanks for your answer ! What was your 3 months like ? did you have to log your food and exercise everyday? Did the doctor office send your logs to Aetna ? How long did it take Aetna to approve your surgery ?

Thanks

[newnatalie 20]

I have Aetna and they were very strict about my doctor visits. I had to see my PCP every 30 days. It could not be one day over 30 days or I had to start over! Honestly, my surgeon had to create a doctor's visit because I went more than 30 days once.

During the 90 days, your doctor is suppose to put you on a diet. How strict the doctor is, depends on the doctor. My surgeon provided me with a form for my PCP to fill out each time I visited. It asks for my weight, blood pressure, a description of diet plan, exercise I was doing, and any other notes the doctor wanted to make. This was helpful, because I was able to personally take this documentation back to my surgeon to submit to the insurance company.

My PCP was not strict about my diet. I gained weight the first 30 days and maybe only lost 5 pounds in the next 2 months. This had no bearing on my approval.

I hope this helps. Good Luck!

[DougNichols 124]

Hey DougNichols,

Thanks for your answer ! What was your 3 months like ? did you have to log your food and exercise everyday? Did the doctor office send your logs to Aetna ? How long did it take Aetna to approve your surgery ?

Thanks

I only saw the nutritionist. Since I had been reading this board for so long, I knew everything she was saying, so she kinda gave up and just handed me the "official documentation" for post-op diet, nutritional guidelines for my 3 months, etc. Our visits lasted like 15 minutes each.

I did not log my food.< /p>

The surgeon's office had to obtain all sorts of extra documentation from different people, which took a week. Then I was approved after another week. Since it was Christmas time, it took a total of 3 weeks from the last nutr appt to approval.

[klus263 9]

For Aetna on my plan with the 3 month plan it also required monthly visit with an exercise therapist. Since we couldn't afford another out of pocket expense for that, my husband is just doing the 6 month plan. I kept my visits pretty close to the 30 day mark but did not go past 30 days. Once they had all my paperwork I was approved in 24 hours.

[Ocean Eyes 1]

When I went the first seminar in September 2010, the doctor informed us that Aetna had a 3 month option. I was determined that I would get all my ducks in a row so that I could have the sleeve done as soon as possibe. I met all the requirements by Dec 9th (3 monthly nutrionist visits, exercise physiologist, pysch eval, web tutorial, and support group meetings). When I asked the staff if they could submit my paperwork for Aetna approval, they initial refused. They indicated that the majority of patients before me who had submitted were denied and had to complete 6 months. I was devasted! When I got home, I immediately called Aetna to inquire as to why, having met all the requirements as defined in their policy, I would possibly be denied. They told me I should go ahead and submit for approval and it should be accepted. When I called the doctor's office back, they seemed really reluctant to submit but I insisted. GUESS WHAT? On December 28, Aetna approved my surgery without question. Hoorah! Needless to say, they were very surprised at the doctor's office. I've been on the fast track ever since to be prepared surgery on Jan 26th. Today, I started my pre-op diet.

The morale of my long drawn out response...don't rely on the doctor's office to fill in ALL the blanks. Make sure you call Aetna to clarify what is required.

[Bryn 3]

i had this question as well. i initially started doing the 3 month option, but my surgeon got rid of her private practice and moved about an hour away and my appts, got switched around so i'm now on the 6 month option. i started in sept. 2010 and saw my PCP 4 times since then. my surgeon stated i only needed 3 meetings with my PCP. but i will reconfirm that when i see my surgeon next month and will call the insurance company. i'm just need to make sure what i'm doing is right. i don't have a ton of support from my surgeon with follow up

[ellawhite77 0]

I just finished my 3 month requirement. Like a few of the other comments, each visit had to fall within 30 days of the last visit, not a day over. My surgeon is submitting my paperwork tomorrow. I never saw my PCP. All my weight management classes were done through my surgeon's office.

[Firefly2 9]

Yep I have Aetna, and did the 3 month requirement. My visits weren't exactly 30 days apart but I did have to make sure that my 4th and last visit was exactly 90 days from my first one. I hear Aetna is a stickler on that. But once all my paperwork was submitted I was approved in no time - well I take that back, I was approved within 24 hours once they found my paperwork that they lost lol....

Good luck!!!!!