Aetna 12 visits - surgeon says 12 months?

[katywv 2]

Hi everyone,

I had my first visit with my surgeon last week. At first, he said Aetna would require 6 months of sessions. I knew about Aetna's new requirement for 12 sessions so I mentioned that and he had his office check again. He came back telling me that the 12 session requirement means I need to do one session per month for a year. That seems to go against what I've read on here, not to mention the wording of Aetna policy 0157 which says "12 or more sessions over any duration of time". Aetna customer service just tells me to check with my doctor. His office is really insistent that even though the wording of the policy seems to imply that any time period is fine, what Aetna really means is 12 months. Is there any written clarification anywhere that I could take to my surgeon? Otherwise I will be stuck with a 12 month program. Thanks!

Edited to change "visits" to "sessions"

Edited March 7, 2021 by katywv

[LoveSimcha 97]

25 minutes ago, katywv said:

Hi everyone,

I had my first visit with my surgeon last week. At first, he said Aetna would require 6 months of visits. I knew about Aetna's new requirement for 12 visits so I mentioned that and he had his office check again. He came back telling me that the 12 visit requirement means I need to do one visit per month for a year. That seems to go against what I've read on here, not to mention the wording of Aetna policy 0157 which says "12 or more visits over any duration of time". Aetna customer service just tells me to check with my doctor. His office is really insistent that even though the wording of the policy seems to imply that any time period is fine, what Aetna really means is 12 months. Is there any written clarification anywhere that I could take to my surgeon? Otherwise I will be stuck with a 12 month program. Thanks!

I don't have Aetna but I handle the medical insurance as part of my job. Generally when they require a "visit" it is usually one a month. I have heard of insurance requiring a year - some only require 6 which is more common but I have heard of 12. I agree with your doctor but I would call your insurance company back and get clarification from them - no way should they send you to the dr for clarification - it is THEIR policy. Ask for a manager at Aetna or a supervisor and get it in writing. I feel like the Aetna reps you spoke too don't know and is trying to pass the issue to someone else. Good luck.

[katywv 2]

Thanks for your response. The word used in the policy is actually "sessions" not visits - I was remembering that incorrectly. Do you think that makes a difference? I will keep trying with Aetna.

[flgirl23 5]

I have Aetna and my doctors said it was 12 visits. It has been once a week for 12 weeks.

[KidaandRoux 10]

Hi everyone,
I had my first visit with my surgeon last week. At first, he said Aetna would require 6 months of sessions. I knew about Aetna's new requirement for 12 sessions so I mentioned that and he had his office check again. He came back telling me that the 12 session requirement means I need to do one session per month for a year. That seems to go against what I've read on here, not to mention the wording of Aetna policy 0157 which says "12 or more sessions over any duration of time". Aetna customer service just tells me to check with my doctor. His office is really insistent that even though the wording of the policy seems to imply that any time period is fine, what Aetna really means is 12 months. Is there any written clarification anywhere that I could take to my surgeon? Otherwise I will be stuck with a 12 month program. Thanks!
Edited to change "visits" to "sessions"

Hello,
Soo...I have Aetna and they did require the twelve sessions but, my doctor's office allowed me to do up to 3 a week. You might mention or show them where it states in your policy that the duration is flexible. I don't believe you should have to do it over a year time frame. Good luck!!

Sent from my SM-N960U using BariatricPal mobile app

[BoyMom86 28]

Hi! I have Aetna- I had to reference the same 0157 info. My surgeons office says it’s 12 visits. I’m doing twice a week x6 weeks.

[flgirl23 5]

3 minutes ago, Stormimeyers said:

Hello,
Soo...I have Aetna and they did require the twelve sessions but, my doctor's office allowed me to do up to 3 a week. You might mention or show them where it states in your policy that the duration is flexible. I don't believe you should have to do it over a year time frame. Good luck!!

Sent from my SM-N960U using BariatricPal mobile app

I agree with Stormimeyers. my doctor's office pretty much told me that it was 12 visits and even said he could have scheduled them quicker than once a week. In fact I think one week I did have two visits but he said he was doing weekly because you have to prove to the insurance that you tried to follow a diet program and it didn't work.

[flgirl23 5]

3 minutes ago, BoyMom86 said:

Hi! I have Aetna- I had to reference the same 0157 info. My surgeons office says it’s 12 visits. I’m doing twice a week x6 weeks.

Wow! That is great. Thanks for sharing that info. My friend and I work at the same job so we both have Aetna and I am sharing this with her- hopefully our doctor lets her do that.

[katywv 2]

Thanks everyone! You're giving me hope! I'm just surprised my surgeon's office seems not to have seen this Aetna requirement before. I know it's newish (from last May?) but they're a pretty huge practice and Aetna is not unusual here.