Aetna 3 month multi-disciplinary surgical preparatory regimen

[fourleaf 6]

I'm just starting the process for trying to have the surgery and while I've participated in medical weight loss stuff in the past, I don't trust that they even took the right records to provide adequate documentation (They could never seem to submit the insurance forms with the right codes, despite claiming to prepare the documentation for Aetna all the time, so I ended up even having to pay most of it myself.)

So, I think I'm going to to do the 3 month multi-disciplinary surgical preparatory regimen through my surgeon's office. There is one complicating factor. My BMI normally hovers around 38-39 but I have gained some weight after my last dieting/weight loss clinic fiasco. So, I'm currently at 41. I know that I am required to lose weight pre-surgery during this regimen but I'm worried that if I lose a pound too much, then I will be denied coverage.

So, I have a few questions for anyone who might know:

• How is pre-authorization for the 3 month plan submitted? Do you do that before the 3 month prep-regimen and do some sort of follow-up or do you submit for the first time after the 3 months?
  
• Also, is the BMI submitted from my initial appointment or is it from right before the surgery?
  

[kraney 219]

I'm sorry I don't know Aetna standards. I am having my operation through a military hospital. They utilize the initial bmi from your first appointment. We also had to do very little to qualify for the surgery. Just attend an informational seminar, lab blood work, and one support group meeting. The whole process took only a month. I wish you the best in your wls journey.

[worm2872 635]

Hi, I had/have Aetna so I can help.

• How is pre-authorization for the 3 month plan submitted? Do you do that before the 3 month prep-regimen and do some sort of follow-up or do you submit for the first time after the 3 months? Everything is submitted after you have completed the three month plan.
  
• Also, is the BMI submitted from my initial appointment or is it from right before the surgery? They used my BMI at the first visit, showed the progress I made and I had to included a 2-3 year weight history. I got this from my OB/GYN.