atena help!!

[misslonglegs 0]

Hello,I am a newbie in my insurance will soon be atena Qpos starting 1/1/09,My question my employer has listed 6months with nutrients in doc...orginally i thought 3 months***please help has anyone had to go thru 6 mos instead of 3 mos with atena?if so how long for approval?:wink:

[silvers320 12]

I did the 6 months for Atena - the first denial came quickly after the 6 months was over ( I would guess within two weeks). It took an appeal which took somewhere between 30-45 days to get finally great approved. It turns out not everything had been submitted or was lost -which caused the first denial. Make sure you document everything. Good luck

[Lady Lap Band 71]

Hello,I am a newbie in my insurance will soon be atena Qpos starting 1/1/09,My question my employer has listed 6months with nutrients in doc...orginally i thought 3 months***please help has anyone had to go thru 6 mos instead of 3 mos with atena?if so how long for approval?

I have Aetna and you first must meet the following:

• Body mass index exceeding 40; or
  
• BMI* greater than 35 in conjunction with any of the following severe co-morbidities:
  

1. Coronary heart disease; or
   
2. Type 2 diabetes mellitus; or
   
3. Clinically significant obstructive sleep apnea (i.e., patient meets the criteria for treatment of obstructive sleep apnea set forth in Aetna CPB 004 - Obstructive Sleep Apnea); or
   
4. Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management);
   

• Member has completed growth (18 years of age or documentation of completion of bone growth); and
  
• Member has attempted weight loss in the past without successful long-term weight reduction
  

You also must meet one of the following 2 criterias:

1. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record at each visit.
   
2. Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions.
   

Originally I thoguht I was goign to have to do the 6 months you are talking about. When I went for my consult the program director said that I would could do number 2 because my hospital has a multidisciplinary surgical program. So after all my test and classes they require it will be about 3 months and I hope that Aetna will be happy.

Here is the direct link I got from Aetna's website that goes into further detail... Obesity Surgery

Also, did you call Aetna to make sure you are covered on your plan? For my plan I am covered up to 90% of all costs. I am pretty sure that is the most Aetna covers.

[nursekathy2u 0]

Hi,

I do bariatirc insurance approvals for a living. Aetna will allow a 3 month multidisciplinary diet and nutrition program OR a 6 month physician supervised diet and nutrition program. However, some employers will require the 6 month diet as opposed to the 3 month program. You should check with them in January and see what your requirements are. Most often it is only the 3 month program. Good Luck!

Kathy

[Lady Lap Band 71]

Hi,

I do bariatirc insurance approvals for a living. Aetna will allow a 3 month multidisciplinary diet and nutrition program OR a 6 month physician supervised diet and nutrition program. However, some employers will require the 6 month diet as opposed to the 3 month program. You should check with them in January and see what your requirements are. Most often it is only the 3 month program. Good Luck!

Kathy

Hey Kathy! That is awesome, thank you very much!

[misslonglegs 0]

Thanks to all,Nurse KATHY I just found out my emplyer wants 6 months....after the 6 month will I likely be approved?

[Flowerpurr 0]

I was approved by Aetna. I had my surgery July 15th. Now I have to tell you Aetna is a pain to get approved but I got it the first time around. I had no co-morbities but I did have a bmi over 40. What I did to get approved was call every day once it was submitted. Than when they had everything and I was sure of it and they were still reviewing it. I faxed in on my own a copy of their clinical policy highlighted with a copy of all the diets I have tried with my weight loss and gain. They really like to see that you are determined before they go ahread and approve. Good Luck! If you play be there rules and follow them to a T you will get it.

[Lady Lap Band 71]

I was approved by Aetna. I had my surgery July 15th. Now I have to tell you Aetna is a pain to get approved but I got it the first time around. I had no co-morbities but I did have a bmi over 40. What I did to get approved was call every day once it was submitted. Than when they had everything and I was sure of it and they were still reviewing it. I faxed in on my own a copy of their clinical policy highlighted with a copy of all the diets I have tried with my weight loss and gain. They really like to see that you are determined before they go ahread and approve. Good Luck! If you play be there rules and follow them to a T you will get it.

What kind of diets did you tell them that you had tried?

[txspatter 0]

I started the 6 month weight management, visiting my PCP monthly July- December. In November, I showed for my appointment, he was having heart issues and in the hospital. Thus. my bariatric coordinator has said, she'll file my records from my visits, but feels Aetna will deny. Can you tell me anything about this? Thanks so much

[silvers320 12]

You didn't say why she thought they would deny, so I assuming because you didn't have visits 5 and 6 - because the doctor is hospitalized. I know that my 6 months were actually closer to over 8 or 9 months - so if the doctor is planning on coming back you do that. Good Luck

[misslonglegs 0]

nurse kathy is the 6 months for atena consitetive?

[Gypsy girl 0]

I have Aetna and did the 3 month program. However, it took about 6 months to get all of the appointments scheduled around my travel for work. Just jump in and do the 6 months if you have to. It might be frustrating to you, but I learned a lot in 6 months and pretty much knew exactly what was going to happen. Toward the end I couldn't think of anything else but my surgery. I was out of the country on business when I was approved and I can't remember the flight home because I was so happy and excited.

There are some good books out there to help us. I think my 6 month wait made it sink in that this is for life. There is before the surgery and after. I am so grateful that I have been banded. I thank God everyday.

You will do fine. Keep moving forward with your plans and don't look back. That 6 months will go faster than you think and you will be wiser for it.

[Lady Lap Band 71]

I have Aetna and did the 3 month program. However, it took about 6 months to get all of the appointments scheduled around my travel for work. Just jump in and do the 6 months if you have to. It might be frustrating to you, but I learned a lot in 6 months and pretty much knew exactly what was going to happen. Toward the end I couldn't think of anything else but my surgery. I was out of the country on business when I was approved and I can't remember the flight home because I was so happy and excited.

There are some good books out there to help us. I think my 6 month wait made it sink in that this is for life. There is before the surgery and after. I am so grateful that I have been banded. I thank God everyday.

You will do fine. Keep moving forward with your plans and don't look back. That 6 months will go faster than you think and you will be wiser for it.

That is so fantastic that you were approved by aetna! Do you have any advice on what to do to ensure we get the same result? How has your weight loss been since you were banded?

[nursekathy2u 0]

nurse kathy is the 6 months for atena consitetive?

yes it should be consecutive

[Gypsy girl 0]

I wasn't 100 lbs overweight or had a 40 BMI, BUT i do have some co-morbidities (sleep apnea, back and neck pain, knee pain, reflux, high blood pressure, high cholesterol and a pretty strong string of diabetics in the family. I am 58 and have tried just about every diet with varying levels of success.

I think what got me approved was that I was and still am so pumped by the opportunity to have this surgery. Staying with the 3 month program and showing that you are compliant is very, very important. Losing weight, beginning an exercise program and documenting your food intake shows that you are ready to do what it takes to be successful. This is the opportunity of a lifetime.

I was banded on Nov. 3 of this year, have had no problems and just had my first fill on Dec. 16 resulting in a 21 lb. loss so far.

God has been good to me and has heard my prayers for many years. Weight has been the #1 stumbling block to me. I feel so grateful that I was able to have the surgery.

Beautiful changes are coming your way. Stay strong and be faithful to the program. Don't be afraid to follow up with your doctor or the insurance company. If they deny you, appeal. Again and again. If that still doesn't work, you have the option of self-paying. Don't ever quit. You deserve to have the beautiful body that God created for you. Anything that matters is always a struggle. Hang tough and let me know how you are doing from time to time.