AETNA INSURANCE? ?

[sfloridasleever 1]

HAS anyone gained any weight during 6 months nutrition visits that has been denied ?

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[sfloridasleever 1]

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[RickM 1,747]

What you need to do is check Aetna's policy bulletin on WLS, which should be on their website somewhere, and see what it says - exactly. That is your legal bible. The main concern that my surgeon's insurance coordinator had was that my PCP's (who "supervised" my six month program) documentation met all of their requirements. The main objective of these insurance diets is to slow down your approval in hopes that you will go away, self pay, or be on somebody else's policy by the time you are ready for surgery.

The insurance company's published policy is the law on this and is what is used for any appeals you may need to do. Not what somebody on an internet forum tells you, or even what the company's phone rep tells you. Some companys will deny coverage as a first step since some people will give up at that point and not appeal, and then they will approve on the second submission when they find their "mistake". If you can't find Aetna's policy bulletin, or can't understand it, check with your surgeon's insurance coordinator as to what it says - it is their job to understand these things.

I didn't lose or gain anything on my six month program and was approved by Aetna, but that was 5-6 years ago and policies can change.

[dede0314 356]

I did. I was denied due to weight gain during the program. I had to go through the appeal process.

[sleever314 44]

I gained 10lbs but they hadn't submit mines to ins. Yet my doctor office said they didn't think I was a good candidate therefore the had a board meeting to see if they would. Well 2 was later I lost that same 10lbs therefore they wanted to move forward with surgery. I am now 6 wks post op.

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[Womanvsmirror 314]

here you go http://www.aetna.com/cpb/medical/data/100_199/0157.html im still pre op but im waiting on approval I gained a few ounces almost a full lb on one of my nut visits (which was not my monthly weigh n ) I freaked out They got my paperwork on 5/2... I call everyday. I have that policy printed and saved I have went through it at least 100 times, if my surgeons office would have missed something , I wouldn't . Now the wait has me stress eating. I need to refocus and loose the 2 lbs I gained since 4/29

[Womanvsmirror 314]

But I have seen some people on here get approve after an appeal , originally denied for gaining weight. I would say try not to gain it, one less thing to worry about later.

[sfloridasleever 1]

Thank you guy so much , I'm just say anxious and nervous ugh , I just want this surgery so bad I'm new here so I'm having trouble trying to post things lol

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[mrsmcline 0]

here you go http://www.aetna.com/cpb/medical/data/100_199/0157.html im still pre op but im waiting on approval I gained a few ounces almost a full lb on one of my nut visits (which was not my monthly weigh n ) I freaked out They got my paperwork on 5/2... I call everyday. I have that policy printed and saved I have went through it at least 100 times, if my surgeons office would have missed something , I wouldn't . Now the wait has me stress eating. I need to refocus and loose the 2 lbs I gained since 4/29

Thank you so much for posting the link. It was very helpful.

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[Womanvsmirror 314]

You are welcome

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[bellabeans 74]

I have Aetna . But it's only a 4 month weigh in . My doc said don't gain and if u lose don't make it a big loss.

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[sfloridasleever 1]

See I had another insurance compatability few months back and they really didn't care if you gained to much as long as you seen the nutritionist and then in the middle of everything I had to switch to aetna and I started reading there policy and everyone was say if you gain any weight you will have a hard time getting approve so within the last 4 months my weight has gone up and down so now 4 my next 2 visits I was told to make sure I go a little bit under my original starting weight I just don't want to have to delay everything with appeals and everything I been waiting for such a long time ! Well it feels like I been waiting long lol

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[Luckygirl8 11]

I have Aetna. I gained 2 pounds in one out of the 4 month meeting with the Nutritionist. The final visit I was down 2 pounds overall. I was approved in a week. I am now 13 days post op. Good Luck!!

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[cache 2]

I had Aetna also. My surgeon told me from day one that Aetna is one of the toughest insurances to get approval from and they want to see no weight gain at all during the 6 month supervised weight loss. I gained 8 pounds in the last 2 months of my 6 months required for approval. My surgeon had me do one week of the liver reduction diet prior to my appointment for month 7 and I lost 12 pounds.....the 8 I gained and another 4. They submitted right after and I was approved in a week. Had my surgery 4/21.

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Edited May 12, 2016 by cache

[findingnish 39]

I gained and was approved by aetna

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