Aetna...What did you do to get approved?

[Brn2blossom 88]

I had an Aetna case manager (Nurse) call me. She asked a bunch of normal Dr questions and if i would have a driver, and support at home. Does this mean Aetna is going to approve me? Why would they assign a case manager to me if they were going to deny me? At least I know theyve received the paperwork....getting anxious. Any hints in what being assigned a Case Manager means?

[cavery77 39]

I also have Aetna. These were my requirements:

3 month plan

1 psych visit

3 nutritionist visit

Monthly doctor visit

EGD

DOes anyone know if they pay for Tummy Tuck after weight loss?

[hdbratt 2]

^{I have Aetna POS2 and they aren't covering my sleeve. I looked through my paperwork and it states right there NO on bariatric surgery. Even though I have a BMI of 38.9 Diabetic type 2 and High BP. Guess it's the way your plan is written with the company you work for. So Mexico here I come.}

[cavery77 39]

Yes depends on the coverage your company purchased

[Brn2blossom 88]

I had an Aetna case manager call me to go over time off/surgery after care/main meds/medical history. Is this a good sign? She said it just means Aetna got my paperwork....but why would they waste their time if I was denied...hmmm. Hoping for an answer this week!

[cavery77 39]

Yes I think that is a good sign lol

[Brn2blossom 88]

I sure hope so....also...didn't realize i posted the same thing twice.lol. shows you whats on my mind!

[rebekah93 0]

Mike4132,

When you say 2 years of height/weight info showing obesity levels of weight, does this mean that I need to have 2 years of documented weight info?

The last time I went to the doctor, my weight was 230-ish at the height of 5'9 and this was during summer 2013. From late summer 2013-mid 2015 I had issues getting to a doctor about my weight due to the fact that I lived in another state (for college) and the one from my home state was not transferring my records to a new doctor (long story). Ever since I went to college, my weight went up dramatically without me even being aware. I was about 190 when I went and was shocked to see that within 2 months, my weight was up to 230! I didn't overeat and actually ate like I normally did at home.

At home, my weight was always stable no matter what I ate. But when I moved to a new area, the food was completley different and more fattening. Well fast forward to 3 years later, I work out, I clean eat and the weight just won't come off. I've successfully lost weight and transformed my body before going to college, but the same methods won't work anymore. I'm worrried that the lack of doctor visits will make it hard to prove my height / weight info showing my obesity levels since I went to college. Does this mean I have to wait another 2 years just to get a surgery with Aetna?

My paperwork was submitted today by my Dr's office and I have Aetna Choice POS II. I will let you know how it goes.

They are submitting:

-documented BMI of 40 with sleep apnea as a co-morbidity
-psych eval
-nutritionist visit eval
-6 month weight loss trial results
-2 years of height /weight info showing obesity levels of weight
-letter of medical necessity (from the weight loss trial Dr.)

I hope all goes well but we'll see. My Dr office claims Aetna is usually easy to work with for approvals. They are estimating 2-4 weeks for a decision. I'll be calling Aetna on Monday to see if they received the info.

[kjsweigart 15]

They no longer have 2 year weight requirement.

[rebekah93 0]

Wow really? That's great news! Where is this information because I was going through the CPB 0157 policy and it says "for adults aged 18 years or oler, presence of persistent severe obesity, documented in comteporaneous clinical records, defined as of the following...."

I assumed that because of "presence of persistent severe obesity" they wanted records of my BMI exceeding 40.

They no longer have 2 year weight requirement.

[kjsweigart 15]

My bmi is over 40 which is documented in my 3 month program. According to my doctor that is what they want to see with no comorbitities. Mine has been submitted. I will post my update hopefully soon

[rebekah93 0]

Ah, I understand now. I would love to see your update. I am still trying to understand how it works in order to be approved by Aetna for a surgery. The 3 month program is something Aetna requires you to do before actually being approved for the surgery?

My bmi is over 40 which is documented in my 3 month program. According to my doctor that is what they want to see with no comorbitities. Mine has been submitted. I will post my update hopefully soon

[kjsweigart 15]

Correct. It is a 3 month or six month program depending on doctor. Mine was 3 months.

[khaled 23]

Correct. It is a 3 month or six month program depending on doctor. Mine was 3 months.

I finished the three month supervised diet, unfortunately I gained one pound. Would this little gain get me denied ?

[kjsweigart 15]

According to my doctor yes.....I lost a lb. I am currently waiting on my approval from aetna.