Aetna POS

[britt_will_getsleeved17 0]

Hello,

Does aetna require a endoscopy before gastric sleeve approval? Also what requirements did you do? 3 months or 6?

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[Ipeek90 64]

Hello,

Does aetna require a endoscopy before gastric sleeve approval? Also what requirements did you do? 3 months or 6?

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This will not be helpful, but I do have my first appointment on Thursday and I've got Aetna POS II so I'll see what they say and try and let you know.

I do know that it's either or for the 3/6months plans and the bariatric clinic I will be using does the 90 day program. So I don't know that it's a choice, more so that the office decides the route they take or prefer you take.

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[TXJess 98]

Even if they don't, you want one. I ended up having to change to the bypass because they found bile in my stomach and evidence of reflux. If I would have just gotten the sleeve I would have had to do the second surgery to fix it.

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[gonefromhere 32]

Aetna does not require an endoscopy. Their requirements are here, I recommend reading through them!

http://www.aetna.com/cpb/medical/data/100_199/0157.html

I did the 90 day plan, and they approved my surgery within a few days of submission.

Hello,
Does aetna require a endoscopy before gastric sleeve approval? Also what requirements did you do? 3 months or 6?


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[olamae 16]

Depends on your policy if you need an auth for the egd. Call the benefit line, but most likely no!

[Ipeek90 64]

Hello,

Does aetna require a endoscopy before gastric sleeve approval? Also what requirements did you do? 3 months or 6?

Sent from my iPhone using the BariatricPal App

This will not be helpful, but I do have my first appointment on Thursday and I've got Aetna POS II so I'll see what they say and try and let you know.

I do know that it's either or for the 3/6months plans and the bariatric clinic I will be using does the 90 day program. So I don't know that it's a choice, more so that the office decides the route they take or prefer you take.

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Just had my appointment today, it's a choice. I chose the 90day which will really be 4mo I guess because of the way the appointments have to be staggered.

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[TieHillATL 28]

I have the most Expensive Aetna plan with my job. I only had to do a 90 Day Supervised Diet where you cant gain 1 pound. As far as Endoscopic Testing I didn't have to. We had a pre-approved amount including for my skin tightening option if I needed. My out of pocket towards the surgery was minimum.

Tie Hill Samsung S6+

Edited January 12, 2017 by TieHillATL

[Ipeek90 64]

Also no endoscopic on mine either. Forgot to mention that.

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[olamae 16]

I have the most Expensive Aetna plan with my job. I only had to do a 90 Day Supervised Diet where you cant gain 1 pound. As far as Endoscopic Testing I didn't have to. We had a pre-approved amount including for my skin tightening option if I needed. My out of pocket towards the surgery was minimum.

Tie Hill Samsung S6+

Not a gain at any of your weigh ins right?

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[gonefromhere 32]

I gained from apt 1 to 2, but they only submitted my weight from apt 1 and 4, and I had lost the little gain by then. Had no problems.

Not a gain at any of your weigh ins right?


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[PAguy 27]

Has anyone done the Aetna 3 month option? I have Aetna HMO and this is what I am required to do, but I don't quite understand it...

Multidisciplinary surgical preparatory regimen:

Must be at least 3 months in duration; and
Family physician must specifically document that you are starting the 3-month surgical preparatory program;
Occurred within the 6 months prior to surgery and
Consultation with a dietician or nutritionist; and
Reduced-calorie diet program supervised by dietician or nutritionist; and
Exercise regimen to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and
Behavior modification program supervised by qualified professional; and
Family physician must specifically document that you have completed the 3-month surgical preparatory program.

I saw my Primary care and started the 3 month program, I am also going to see a nutritionist next week.

But I am confused about the rest... Do I need to see an exercise therapist too? I don't even know how to go about finding one.

Also, what is the behavior modification program? Is that separate from what my primary care doctor is doing? Do I need to find this program?

Why is Aetna so confusing!!!??? Ugh.

Any help would be amazing!!!

[Ipeek90 64]

Has anyone done the Aetna 3 month option? I have Aetna *** and this is what I am required to do, but I don't quite understand it...

Multidisciplinary surgical preparatory regimen:

Must be at least 3 months in duration; and

Family physician must specifically document that you are starting the 3-month surgical preparatory program;

Occurred within the 6 months prior to surgery and

Consultation with a dietician or nutritionist; and

Reduced-calorie diet program supervised by dietician or nutritionist; and

Exercise regimen to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and

Behavior modification program supervised by qualified professional; and

Family physician must specifically document that you have completed the 3-month surgical preparatory program.

I saw my Primary care and started the 3 month program, I am also going to see a nutritionist next week.

But I am confused about the rest... Do I need to see an exercise therapist too? I don't even know how to go about finding one.

Also, what is the behavior modification program? Is that separate from what my primary care doctor is doing? Do I need to find this program?

Why is Aetna so confusing!!!??? Ugh.

Any help would be amazing!!!

So I'm doing the 3mo route with behavioural modification plan as opposed to the 6mo physician maintained diet and weight loss option.

With the 3mo plan, it's actually 4 months. You have to have 4 nut/dietitian appointments and with in 7 days time you have to have an appointment with say a physical therapist. I'm pretty sure you have to have a psych eval, I do, and I assume it's an insurance requirement and not one from my surgical team.

As far as what the behavior modification plan actually is, I think there is a grey area there. I remember either reading on hearing that term used when researching my surgeon. They use that program and I believe it's just everything you're already doing. As I get closer to surgery date I will be having some pre-op classes and I think that's part of it as well.

Other things you may need, blood work, upper GI and others depending on your overall health.

To your question about the exercise therapist, when I went to my surgeons office, they have a dietitian on site and referred me to a physical therapist who work with obese patients getting ready for surgery. So just ask your doc or your surgeon if they can refer you. But MAKE SURE YOU SEE THE EXERCISE THERAPIST WITHIN 7 DAYS OF NUT/DIETITIAN VISITS. They told me they had a patient schedule on like say 8 or 9 and was denied because of it.

And with the 3mo Aetna does not require you to loose a specific amount of weight, you simply can not weight as much as your initial visit. Your surgeon may require some weight loss and it's always good to lose some before the surgery to lower complication chances.

Hope this helped.

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Edited January 30, 2017 by Ipeek90

[Kcle 0]

Hi everyone! I am new to this forum. I also have Aetna and am confused by the whole thing. I am scheduled for my first three hour seminar appt that will cost 600.00! Out of pocket. With Emory Hospital. I am doing it there since I am an employee. I have the physician's letter and approval. It is kind of gray what the 3 month diet thing is all about. Is it a lot of appointments that mean missing work? Thanks!!!

[Ipeek90 64]

Hi everyone! I am new to this forum. I also have Aetna and am confused by the whole thing. I am scheduled for my first three hour seminar appt that will cost 600.00! Out of pocket. With Emory Hospital. I am doing it there since I am an employee. I have the physician's letter and approval. It is kind of gray what the 3 month diet thing is all about. Is it a lot of appointments that mean missing work? Thanks!!!

Wow $600 that is crazy! My initial visit with the surgeon was $220 and that included the dietitian. I did the seminar online though, so maybe the hospital is charging an up charge for some reason.

You're going to require 4 visits with a Nutritionist/Dietitian, 4 visits with a physical therapist/exercise therapist within 7 days of your nut/dietitian appointments. Those should be roughly 2hrs total, 1 per appt. This is the 3mo plan and everything I've read and been told, you can not gain weight from your initial visit. So they take your weight each visit, but only submit appointments 1 and 4. So as long as 4 is not higher you should be good to go.

You will need a psych eval, mine was about 1.5-2 hours, spoke with the psychiatrist for 30-45min and spent the rest of the time answering true false questions, roughly 500 of them, it cost me $360 out of pocket (thank you HSA account).

And then you're going to need the normal blood work, possibly an upper GI/endoscopy (depends on Dr I think) and EKG.

Outside of that I don't know much else. That's what I've been told. I've gone to my first dietitian and physical appointments so far and had my psych eval yesterday. Had a physical on Monday for blood work and EKG.

Hope this helps.

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Edited February 1, 2017 by Ipeek90

[PAguy 27]

They submitted my paperwork to Aetna on Friday, but after reading all these forums I am worried. From my 1st appointment to the last one I was up 4lbs. Nowhere did it say that I could not gain any weight during the process.

Now i'm pissed off because I am for sure going to be denied, but how was I supposed to know?