AETNA 3 month or 6 month?

[olamae 16]

I am going on Aetna on January 1st, has anyone done the 3 month multi discipline or 6 month supervised dieting? What did they require that you do?

[acaldero 1]

I am 3 1/2 weeks post op and have Aetna. I only had to do 3 months but you can call them once you have it and ask to be sure.

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[olamae 16]

Did you have to have a history of obesity with them? The policy guide says 3 or 6 month but I want to be sure.

[NewLA 31]

I'm 3 weeks out and also only had to do 3 months. It does vary....I had a list of things to do to get approval and you can't have any net gains

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[kingcake 19]

What exactly did you do . I'm shooting for 3 month. As far as exercise was was acceptable documentation ? No net gain but what happens if you loose weight during the 3 month period ?

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[NewLA 31]

In my 90 days I stayed between

Cardiac Clearance

Chest/Abdominal/Leg X Ray's

EGD and Upper Something

2 Support Groups

Pulmonary Clearance

2 year Weight History

Psych eval

2 Support Groups (I think this is a surgeron requirement)

3 weigh ins with no net gain...

I think that's about it...I don't have my list in front of me

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[olamae 16]

When you say net gain is that at the end of the 3 or 6 month you can't be over the start weight? Or Can you not have a gain at any appointments during that duration?

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Edited July 25, 2016 by olamae

[NewLA 31]

Mine was at the end....which was what delayed me cause at my last weigh in the month of May I was up 4 pds. That lead me to June... after that final weigh in...I had surgery 2 weeks later

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[aslcertified 86]

_{Good Morning everyone! I needed some feedback and support regarding insurance not paying for bariatric surgery, I also have Aetna POS here in Louisiana and I too went through the 90 day program one of Aetna requirements, I fit all of the criteria and just last week received noticed I was denied because I gained 1 lb and did not schedule my procedure within 6 months of my initial start date. I was in shock, upset, and very disappointed. how can this be, initial program date 6/25/15 last weigh in date 9/16/15 and immediately was denied, I researched and hired obesity advocate /attorneys to fight this since Dec 2015 to start the first appeal process and last week the appeal was denied because I gained 1 lb. I do not understand that policy, I weighed in summer which means my clothes were lighter, then last weigh in was September which my clothes would have been a little heavier 1 lb is not a significant amount of weight to consider because 1 to 2 lbs can come from many factors such as clothes, time of the month, or if I had a snack or lunch prior to the appointment my clothes alone would weigh 1 to 2 lbs COME ON'. I can understand if I gained 5 lbs to 10 lbs of weight. OMG!! I want to scream...... Has anyone experienced AETNA denying surgery for weight gain and then was approved after it was appealed first or second time? Now we are going for round 2 and want to know if it is worth it bec I am so disappointed with Aetna. HELP!! please ADVISE!!}

[Womanvsmirror 314]

search this site for the word Aetna a lot of people got approved n appeal . I was so terrified of weight gain during the process , I was on laxatives and liquids only 48 hours before each weigh in

_{Good Morning everyone! I needed some feedback and support regarding insurance not paying for bariatric surgery, I also have Aetna POS here in Louisiana and I too went through the 90 day program one of Aetna requirements, I fit all of the criteria and just last week received noticed I was denied because I gained 1 lb and did not schedule my procedure within 6 months of my initial start date. I was in shock, upset, and very disappointed. how can this be, initial program date 6/25/15 last weigh in date 9/16/15 and immediately was denied, I researched and hired obesity advocate /attorneys to fight this since Dec 2015 to start the first appeal process and last week the appeal was denied because I gained 1 lb. I do not understand that policy, I weighed in summer which means my clothes were lighter, then last weigh in was September which my clothes would have been a little heavier 1 lb is not a significant amount of weight to consider because 1 to 2 lbs can come from many factors such as clothes, time of the month, or if I had a snack or lunch prior to the appointment my clothes alone would weigh 1 to 2 lbs COME ON'. I can understand if I gained 5 lbs to 10 lbs of weight. OMG!! I want to scream...... Has anyone experienced AETNA denying surgery for weight gain and then was approved after it was appealed first or second time? Now we are going for round 2 and want to know if it is worth it bec I am so disappointed with Aetna. HELP!! please ADVISE!!}

[Womanvsmirror 314]

im about 8 weeks post op now with Aetna pos as well did the 3 month program

first visit was 1/29 last was 4/29 //surgery was june 1st

did gain almost 2lbs on one visits but thank god it was by nut visit not one of my weigh ins that counted

I had the following

2 nut

3 weigh ins/behavior modification( discussed food and exercise set goals)

sleep study

psychiatric eval

upper gi

blood test

one meeting with surgeon

Approved in 12 days

then after I had leg xray

more blood work

ekg

another nut class/preop instructions

and last meeting with surgeon 2 days before

Have you read aetnas clinical bulletin its on the site the number is cp0157

I am going on Aetna on January 1st, has anyone done the 3 month multi discipline or 6 month supervised dieting? What did they require that you do?

Edited July 25, 2016 by Womanvsmirror

[olamae 16]

So to be safe dont gain any weight within the 6 or 3 months???

[Womanvsmirror 314]

Correct

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[aslcertified 86]

Thank you ! I will check it out

[aslcertified 86]

Yes I agree do not gain weight not even an ounce.