Aetna Requirements

[Delta_35 129]

Hello!!!

I am new to the forum and have a question about Aetna approval for the six month track. On Monday I finished my last weigh in at my doctors office. I called my surgeons insurance coordinator to tell her I was all done and was ready for her to submit my information. She then informed me that I was required to have a psych eval. Now, I have read the bulletin a million times for the physician requirements and no where does it state the psych eval as a requirement. It does state it though for the multidisciplinary track which is only 3 months. I told her I called Aetna and they said I did not require it, but she claims they are telling her I need it. I am really getting sick of going back and forth, so tomorrow I am going to tell her to submit it and if it gets denied for that, I will appeal!! I know how to read and i know what they told me. I did the 6 months of nutrition,exercise plan, etc so Aetna better keep their end of the deal! Anyone been through something similar with Aetna??? Or have done the 6 month physician track?

[MRMROMA 0]

hi,,,,,

i have Atena too and for sure they required to do psych eval, so you must do it and plz do not wasteyour time and take an appointment as soon as possible and do not let them denied it.

Thank you and tell me what happen with you

[Delta_35 129]

Yes they do...but that is for the 3 month multidisciplinary track...not the 6 month physican supervised and i even called them and when we went over the bulletin, and they agreed. I don't know..maybe I will just do it anyway but I don't see why I have to if its not required per the bulletin if you choose the 6 months. I feel as though my surgeon office is saying it because everyone they submit do the 3 months,not 6. I will let you know what happens...how many months did you do?

[MRMROMA 0]

Yes they do...but that is for the 3 month multidisciplinary track...not the 6 month physican supervised and i even called them and when we went over the bulletin' date=' and they agreed. I don't know..maybe I will just do it anyway but I don't see why I have to if its not required per the bulletin if you choose the 6 months. I feel as though my surgeon office is saying it because everyone they submit do the 3 months,not 6. I will let you know what happens...how many months did you do?[/quote']

The hospital that I am going to do the surgery in it they ask me to do just 3 month daitation but I did not do yet my first appo will be in 4/12

[Jocy 10]

My advise to you is to do everything they ask you to do cuz it's a long process after that. You still have to meet with your surgeon to sign off consent forms and then go to a seminar and then meet with the anesthesiologist and from there go to have your PST's. I have Aetna too and since this surgery is for you and you are the one interested. You should do everything they ask you to since they deal with lots of cases daily and besides remember they are the ones who say when to send it or not , not you. If they feel they're missing information from you, it will jut be delayed or put as last. I live in new York and the psychologist visit was nothing more than 2 hrs and then she faxed her report to the surgeon maybe within the week. Good luck

[newtonya2012 6]

Hello!!!

I am new to the forum and have a question about Aetna approval for the six month track. On Monday I finished my last weigh in at my doctors office. I called my surgeons insurance coordinator to tell her I was all done and was ready for her to submit my information. She then informed me that I was required to have a psych eval. Now' date=' I have read the bulletin a million times for the physician requirements and no where does it state the psych eval as a requirement. It does state it though for the multidisciplinary track which is only 3 months. I told her I called Aetna and they said I did not require it, but she claims they are telling her I need it. I am really getting sick of going back and forth, so tomorrow I am going to tell her to submit it and if it gets denied for that, I will appeal!! I know how to read and i know what they told me. I did the 6 months of nutrition,exercise plan, etc so Aetna better keep their end of the deal! Anyone been through something similar with Aetna??? Or have done the 6 month physician track?[/quote']

I got my surgery through Aetna and I also had to get it done.

[Mrs. sleeved 1]

Double check my doctors office made a mistake when it came down to what my insurance required . The information they gave me was wrong I only need 4 yr weight history and a BMi of 40 and up no psyc or nutrition but my doctor and hospital did require psyc!!

[Delta_35 129]

JOYCE

Thanks for your comments but I am actually “listening” to what my doctor is telling me. Since I did the six month track, 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.

[yoshikitty 8]

Instead of listening to the responses and guidance of others, you just keep arguing and complaining which will not get you any closer to a surgery date. I have Aetna and did the 3 month plan. The doctor's office asked me to do a sleep study too even though that was not required by Aetna....And you know what I did it because that is how bad I wanted the surgery. If you get denied for not doing the psych test, you will have to appeal everything which could take a looooooooong time. Listen to your fellow sleevers that are trying to help you!

[Jocy 10]

@delta35. Just do what you feel is right. Everybody has their own opinion. I'm happy I got approved and just wish everybody's luck on their own decisions.. 7 more days to go !! Super nervous =)

[Delta_35 129]

Yoshkitty

First of all I am not complaining. I am stating a question and was seeking a response. Please don’t assume to comment on somethng you know NOTHING about. If you read the post, then I am asking people who have done the 6 month track. You did the 3 month track..so really there is no need for you even post on this thread. There is a difference between the 3 month and the 6months requirements for Aetna. And for YOUR information, I am doing what MY doctor told me to do and have completed HER requirements. IF you had read the post, then you would realize that the surgeon office is the one asking for this, not my doctor who is in charge of my fitness, nutrition plan, etc. In the future, please read the entire thread before posting or just don’t post at all. That’s always an option!

[Delta_35 129]

Joyc,

The good news is, Aetna is currently reviewing it and if I need the psych evalaution, i can just do it and submit to them. They are reviewing everything now and will let me know within 7 days. Its not a big deal to do it, but the point is since my docotor was the one who was handeling the requirements(because I did the 6 month) then she wanted it submitted..and so did I. I am going to go along with my docotor because has been the one who I have been completing the 6 month clinical bulletin with, not my surgeon. But as stated, if i have to, I will. Will keep you posted and thanks...and congrats on your approval! I read about it in another thread!

[Delta_35 129]

Well everyone..my surgeons office called me this morning. I was APPROVED!!! YAY!!!!! So I guess me and my docotor was right!!!

I dont have a sugery date yet, will have one by Monday!!!!

[yoshikitty 8]

Just want to apologize Delta. While your thread was pretty harsh, perhaps I deserved it. I am happy that you were approved and again I am sorry if my words came across as negative since it was not my intention. I just didn't want you to be denied, that's all.

Sincerely,

YoshiKitty

[Delta_35 129]

Apology accepted..and really there is no need to apologize. I know sometime I can be pretty darn harsh and to the point. I guess i misinterpreted your email and felt like you were attacking me. Unfortunately, email has the ability to sometime come across incorrectly, since we are expressing ourselves via words instead of face to face. I apologize if my post was harsh; I was just frustrated that no one really understood what I was saying. It happens sometimes.

Sincerely,

Delta