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Aetna Approved!



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I received approval from Aetna! (Aetna POS II). I did the 90 day Multi-disciplinary approach. Technically I started in December, but I had a little hiccup and missed one of my appointments with my Primary Care Doctor in January. All I did was tack on an extra appointment with him in April, and all was good. When I first started I was so confused about Aetna's requirements, so I wanted to share for those that are taking the same route. Here is what I did to get approved.

December:

I met with the Surgeon and bariatric coordinator. I was intimidated about the process because of the insurance requirements. I started a journal to help keep track of my appointments and for a place to relay my thoughts as I went through everything.

I met with my Primary Care doc for appointment 1 of 3.

I met with a physical Therapist office, the week before Christmas, inside of our local YMCA to meet the exercise requirement. I wasn't sure how often I was supposed to meet with them. I scheduled an appointment twice a week. I later found out that once a month would have sufficed.

January:

I met with nutritionist for appointment 1 of 3

I met with psychologist for appointment 1 of 3

I met with Primary Care doc for a reason not related to weight loss, so it did not count as appointment #2, and I had to start over in February with my PCP visits.

I met with physical therapist twice per week.

February:

I met with nutritionist for appointment 2 of 3 (I lost10 pounds at this weigh in)

I met with psychologist for appointment 2 of 3 .

I met with Primary Care doc for appointment 1 of 3 (again...sigh)

I learned that I only needed to meet with the exercise therapist once per month, so I only had one visit this month.

March:

I met with nutritionist for appointment 3 of 3 (I lost 9 more pounds at this weigh in)

I met with psychologist for appointment 3 of 3, and took the evaluation test.

I met with Primary Care doc for appointment 2 of 3.

Since I had already had 3 months straight with the exercise therapist, I did not go anymore after my February appointment. But I did keep an exercise log and gave it to my bariatric coordinator to submit as well, just to help my case.

April:

1 visit with Primary Care doc

For some reason it took my PCP a while to get everything sent over to the bariatric coordinator so that she could submit it for approval, but it was finally submitted on 4/25, and approval was granted on 5/5.

I am 5'9 and started out in December at 290 pounds. As of today I am 259 pounds and I'm proud that I did that on my own. I feel confident and have proven to myself that I can make the lifestyle and habit changes that are required in order to make this tool successful. I was diagnosed with Type 2 Diabetes in December, which lit the fire under me to get serious about my health. I am waiting for a call back from the Bariatric coordinator so that I can get my pre-op appointment and surgery scheduled.

This has been quite a journey so far. I'm excited to watch it all unfold.

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Congratulations!

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Yay! I saw my surgeon today and got my surgery date. June 6!! I start my 10 day pre op diet on May 27

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    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
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      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

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