Imurance is switching!

[heartonmysleevey 133]

Why do you have to do the six month supervised diet with Health Net? I have them also and that is not a requirement for the sleeve. Go look up their National Medical Policy - they no longer require a six month supervised diet for any WLS.

Yep - just checked to be sure. Their National Medical Policy was updated in Sept 2010 to no longer require participation in a supervised diet program prior to approval.

Your doctor might require it, but Health Net does not.

The only requirements for a sleeve from Health Net are:

BMI higher than 40 OR BMI higher than 35 with a severe co morbidity.

Less than 65 years of age.

You must be able to show them that a gastric band (lap band) or a gastric bypass will not be appropriate for you (ie...stomach/bowel issues, taking anti inflammatory meds, etc).

That's it. No supervised diet.

OMG! I could die. My six months would end in septemeber any way. Now that I'm switching it will be effective September 1 st. With Aetna.

Aetna wants 3 months so I'm hoping it just rolls over and I can get approved.

Thanks.

[heartonmysleevey 133]

I started my 6 months supervised diet back in February, so my last month is July...my company was sold July 1st and we have new Insurance as of July 1st which is Aetna

I had completed all the requirements was submitted to Aetna July 25th was approved on July 28th. So I think as long as you meet their requirements I don't think you will

have a problem,,, I

Wow that's really great! I hope I have the same luck.

I still haven't done anything like any of the other evaluations.

I should probably get all of those things out of the way.

Thanks.

[RSREED53 4]

Natasha, I would get all prelims done asap. Document to the maximum!! If you have any cardio and pulmonological screens, and clearances, get them sent to surgeon and keep copes of all reports, diagnoses, and the like--also xrays. When Aetna coverage kicks in, those records can be used by the surgeon to submit to Aetna for approval. Your preop supervised diet records should be enough to override requirements of the 6 months, esp if you have comorbid symptoms currently. I was persistent for 4 solid years before surgery on May 31. You must be proactive with all parties from doctors to insurances to get this surgery. It is worth your life! I am so glad I did it!!