Aetna Requirements

[robinagogo88 12]

Can someone please explain the difference between the 3-month track and 6-month track for Aetna? I have Aetna *** (California) and I was told it was a a 6-month medically supervised diet. Does it vary from state to state? How do I get on the 3-month track? Thanks and good luck to all of you!

[Delta_35 129]

Hello!

Well first of all go on Aetna and check the medical bulletin. It should have two options, a 6 month physician track or a 3 month multidisciplinary track.

I did the six months because I was not sure about the surgery. For the 6 month you have to get your doctor to put you on a nutrition plan and a exercise regimen. My doctor just gave a me handout on meal planning and told me exercise at least 3 times week. Then every month, for 6 months, I weighed in. I also had to submit 2 yrs of weight history, which was just a copy of my medical records from the past two years when I came in for other issues. Also make sure that every time you visit for your weigh in that your doctor documents it in your medical notes.

Now for the 3 month, its different. Instead of going to your primary care doctor, the requirements are usually done by your surgeon’s office. You have to meet with a nutritionist/dietician, a fitness/exercise therapist, and a behaviorist. Also you have to have a psych eval.

In addition to the Aetna requirements, you have to fulfill the surgical requirement from your surgeon, regardless if you do the 3 or 6 month. Like I said though, check your policy online. Log on Aetna Navigator and type in obesity or you can just call Aetna and ask them what the requirements are. The clinical bulletin that list the requirements are Obesity Clinical Bulletin 157. Check that bulleting on your policy and see if it states the same requirements or call them.

Hope this helps, keep me posted! Hope you can do the 3 months!

[Pteri 1]

Robin,

It may also depend on the doctor/facility you are using -- I was able to get approved by Aetna on the three month track, but only because I used the program at Emory. Elsewhere I would have had to do six months. The Emory Bariatric Center had the whole thing down like clockwork, so I just trusted their instructions on what it would take to get approved. If there is a place near you that is comparable to The Emory Bariatric Center, they may have the option of putting you through the three month program.

Teri

[MRMROMA 0]

Hi DElta,,,, Congratulation I am super happy to you I will pray for you and keep post me good Luke

Bye bye

[MRMROMA 0]

Hi DElta' date=',,, Congratulation I am super happy for you I will pray for you and keep post me good Luke

Bye bye[/quote']

[littlebits 154]

JOYCE

Thanks for your comments but I am actually “listening” to what my doctor is telling me. Since I did the six month track' date=' my physician was the one who was ensuring the Aetna requirements were being completed. Once I found my surgeon, I had to complete his requirements as requested. I have done everything they have asked me, the problem is the surgeon office is trying to tell me that the Aetna requirements are not all fulfilled, even though my physician says they are. I did read over the bulletin with the surgeon coordinator and she then agreed with my physician. My information has been sent to Aetna for precert so we will see what happens. If Aetna says I need the psychologist visit, then I will do it before my surgery date. Oh and all the doctors I talk to down here said it would be a 2 to 3 week process for me to complete the psychology requirements…not sure why it can’t be as you stated for you, which seems to be a quicker process.[/quote']

I had my psych eval on Monday. She literally talked to me for like 15-20 minutes & was satisfied with my responses. Apparently, I was good to go b/c I didn't have any mental health issues.

I too had to do the six months of supervised visits through BCBS of DE. I have my 5th visit with the nutritionist on Tuesday & one more in May. Good luck with the rest of your process!

Little bits

[Delta_35 129]

Thanks Little Bit. I hope your process goes well. Believe it or not, I could had did the 3 month track, but I chose to do the 6 month instead. My surgeons office tried to push me to do the 3 month but I wanted to work on the longer track instead. I wanted to make sure I at least tried to lose weight on my own before i made the decesion to have surgery.

Also I am glad your psych eval went well. i didnt have to do it with Aetna..but alot people at my surgeon office are having a hard time finding someone who will give them a psych eval without having them go for multiple visits. Anyways, keep me posted on your process and good luck!

[Delta_35 129]

Thanks MRMROMA!!!

[littlebits 154]

Thanks Little Bit. I hope your process goes well. Believe it or not' date=' I could had did the 3 month track, but I chose to do the 6 month instead. My surgeons office tried to push me to do the 3 month but I wanted to work on the longer track instead. I wanted to make sure I at least tried to lose weight on my own before i made the decesion to have surgery.

Also I am glad your psych eval went well. i didnt have to do it with Aetna..but alot people at my surgeon office are having a hard time finding someone who will give them a psych eval without having them go for multiple visits. Anyways, keep me posted on your process and good luck![/quote']

I will definitely keep you posted & congrats!!!

Little bits