Aetna and Tests/History Required - Need Your Best Advice

[CelticBeautyEvolving 23]

My initial appt is next Thursday, April 11th. My BMI is 53, and has been 50+ for over 3 years now. I have Aetna, and they do cover Bariatric — the way I read the policy, they will require 3 months of pre-op visits with a nutritionist, medically supervised weight loss to prepare for surgery, yes?

Here is my challenge...my policy runs from Sept 1 to Sept 1. Right now, I have met my entire deductible, and almost all of my out of pocket, thanks to a week-long hospital stay early in the plan year. If I can get this procedure done before Aug. 31, I will only be out-of-pocket a small amount...

What can I do to help the process along? What kind of records are they going to need from my PCP? Any advice that those of you have already walked this road can give me will be greatly appreciated!!

[Briswife15 890]

I have Anthem BCBS, and was also required to have documentation that I had tried numerous different weight loss plans, over many years, with no success. I think If you have your 3 visits in April, May, and June you should be all set to have your surgery before August 31st. Wishing you all the best.

Sent from my SM-N960U using BariatricPal mobile app

[SusieQ2019 567]

I have Aetna, and my advise to you is once you go to your appointment on the 11th and they provide you with all of the requirement make them as quickly as possible. The requirements for me were, endoscopy, 4 consecutive monthly, visits with my surgeon, cardiologist, psychologist, sleep test, 3 consecutive visits with a physiatrist, 3 consecutive dietitian visit, stress test, a visit to see my PCP for clearance. It is also require me to get one last pre-op class, and meeting with the anesthesiologist and blood work. If you smoke you will need to be off nicotine and may nee to do other test(I am not a smoker so not sure on the test.). Lastly some surgeon require a liver shrinking fast. Mine is for 14 days. I seen where some people have to do one week, a few days, one month or not at all. Make sure you ask as much questions as possible so you understand the process and the requirement.

I started my in October, but I choose to spread my appointment out, as all the appointment became overwhelming and I had my mind set on April. I will be having my surgery April 29th.

I hope this helps and wishing you the best.

[CelticBeautyEvolving 23]

That’s exactly what I need...a checklist of the visits I need to schedule, so I can get it all done. At this point, all of those visits will cost me very little, since I’ve met my deductible, so there’s no $$ barrier to getting them done quickly...I don’t smoke. I had a colonoscopy done when I was hospitalized back in September, but they probably want an EGD?

I don’t smoke - hubby is a double lung transplant recipient, so we are all about being smoke-free, and very, very compliant with meds!

By “consecutive visits” - do you mean monthly?

Thank you!!

[SusieQ2019 567]

I cant imagine whats it like to go through a double long transplant, and wish you and your hubby a lifetime of good health.

Yes exactly about the same time each month. They will count the 11th as your first visit, what you can do if possible is ask if you can meet with the nutrition on Wednesday. If not, no worries you can make the appointment for the same day on your other visits. If you haven't as yet make sure you find out if your surgeon is within network.

I reached my deductible with my sleep Apnea test and my responsibility will be 10% for the procedure which will be well worth it.

[CelticBeautyEvolving 23]

I went through a bunch of old medical files today, and I have records dating back to 2011 showing my weight...basically, I've been in the "obese" category for at least 10 years...

My surgeon is Dr Mehta, at Texas Laparoscopic Consultants, and they are in network.

I do have questions about all the procedures/tests that need to be done for approval -- does it matter which doctors are used for those? If I already have a psychiatrist / GI doc / etc, can they do the psych eval, EGD, etc, if that's the quickest way to get it done, or do the surgeons generally want you to use someone in their "network"?

[Cheeseburgh 3,083]

I have Aetna. My Doctors office had a checklist of everything and all appointments needed. I imagine yours does too. Once everything was complete and submitted they sent it to Aetna and I was approved in a week. I believe I was 4.5 months from start to finish. I think that is best case scenario. I was pretty lucky, none of my appointments took a long time to get and I didn’t have any complications that would have extended my time. I had to go to 3 appointments with the nutritionist and could not gain weight. I had to have a home sleep study, get an endoscopy, bloodwork, see surgeon twice, see a psychologist and I think a pulmonologist. I would have to go through my folder to be certain.

I think you can use whatever Dr you wish if you are willing to pay for it. Aetna does not cover the psych evaluation, however they require it. It is a long computerized questionnaire administered by a psychologist. I think it was $150 or so.

My Doctors office told me they make sure they cover all the bases so your insurance can’t say no. Aetna actually had a nurse call me for a few months following the procedure to see how I was doing and asking me if I needed anything.

Edited April 4, 2019 by Cheeseburgh

[SusieQ2019 567]

At my first visit my surgeon's nurse provided me with a list of department with the name of doctors who perform test and procedures. Since you already have doctors please check with Dr. Mehata to see if you can use them, especially the psychiatrist since you already established a relationship. If not ask if they have a team of doctors with whom they work with.

I did all of my procedures/test at Mt. Sinai in NYC because it's the hospital I've been going to for everything for quite a few years. Because they already have my medical records, it made it easier for my surgeon to have access to all of my results.

Best...

[SusieQ2019 567]

Like cheeseburg, my doctors office made sure they covered all the bases.

[Cameo325 27]

I also have Aetna. Requirements are similar as others have posted. 4 consecutive visits with the surgeon, 4 visits with a dietitian, EGD, Psych eval, EKG & blood work. I'm already diagnosed with sleep apnea so a sleep study was not required. I'm still in the process of getting all this done so I haven't been approved yet. Hoping to by the end of the month so I can have surgery May 16th. Good luck!