AETNA- MISSING PHYSICIAN MONTHLY VISIT PAPERWORK

[D.Lo 8]

Hello all. I have an Aetna plan which does allow for the Bariatric Surgery. I completed all of my requirements including my 4th Nutritionist visit this past Monday 8/25. Needless to say, I was overjoyed because my paperwork was about to be submitted any day now. Much to my dismay, the insurance coordinator at the Bariatric surgery office called me to tell me he was missing the paperwork from my Physican which shows that I was seeing him in conjunction with my nutritionist visits from (May 2014-Aug 2014). I told him that I was not aware that this was needed. He said it was on my Pre-Determination Checklist and we discused it back in April. I referred back to the checklist and it states the following:

"AETNA- REQUIRES NUTRITIONAL AND PHYSICIAN MONTHLY VISIT (90 DAYS FROM START TO FINISH-4 NOTES ARE NEEDED TO DEMONSTRATE COMPLETION OF PROGRAM AND MUST NOT GAIN WEIGHT DURING THE PROGRAM"

I guess I missed it (althought, I believe that the inusrance person should have been verifying as to whether or not I had all the required forms at least 2 months in so around July)

There are certainly 4 notes as they require above, but they are all from the Nutritionist. Now I dont know what to do?

1.) Do I submit packet as is without the physician notes and hope they approve?

2.) Do I ask my doc to write a letter stating that I did see him during this time and see if he will do?

I am afraid that I will need to complete this entire process all over again if I am denied. Has anyone else had this issue or similar?

Any advice would be apprecaiated.

Regards!

Edited August 28, 2014 by D.Lo

[Krystal W. 13]

So I take it you did see your Family Dr in conjunction with the nutritionist? Just call over to the family Drs office and have them fax those two notes, the insurance is looking for 2 things, dates with the weigh-ins and that there is a diet mentioned. That's all they want, I would not send in your packet until you get that together. I had a hang up because of it and was denied over those notes, it was then told to do a peer to peer review, extra waiting and finally got the ok. But if I had to do it again or was in a rush, I would have verified that and waited a day to send it. My insurance didn't get back to me for close to a month initially and the peer to peer was scheduled with the surgeon with the papers in hand, once they had it I was approved.

[D.Lo 8]

Krystal

Thanks for the reply. I mentioned that I wanted to have this procedure done to my family physician back in early April. I had a physical done at that time. Then I didnt see him again after that. I just did everything with the Bariatric Surgery office. Their nutritionist on staff. I visited her in May, June, July and August. But no, I did not visit my primary physician at all during those 4 months. I thought all my weight info was being documented and taken care of at the Nutritionist visits.

I guess from reading below I needed to make Primary care visits on the same days as the nutritionist visits and document 2 weigh ins? It's just not clear enough...you know?

"AETNA- REQUIRES NUTRITIONAL AND PHYSICIAN MONTHLY VISIT (90 DAYS FROM START TO FINISH-4 NOTES ARE NEEDED TO DEMONSTRATE COMPLETION OF PROGRAM AND MUST NOT GAIN WEIGHT DURING THE PROGRAM"

[D.Lo 8]

Just an update. I submitted the paperwork as is and I was approved in less than a week! My surgery date is 10/13!!!

AETNA ROCKS!

[dede0314 356]

Congrats on your approval. I am just starting the process with Aetna so all you did was visit the nutritionist for 3 months. DId you do anything with an exercise therapists?

[D.Lo 8]

Yes, I visited the nutritionist at my doctors office for 3 months, I had a psych evaluation and that's it. Your surgeon's office should have given you a list of what you should have completed. I would recommend that you do exactly as they suggest so that there is no question when your packet is submitted. Does your surgeon turn in all the paperwork for you? Mine did, they were very helpful. Good Luck.

[Ladiec2 74]

OK...hello. I too have AETNA and they have a 3 month and a 6 month program. I've been wanting to do this for a long time and finally decided to buckle down and get it done. I'm very impatient therefore I want to go the 3 month route and have it done around the beginning of the year. What did you do to go thru the 3 month route?