Aetna Approval Requirements... I'm feeling discouraged :-(

[blondediva8 0]

I just checek with my insurance...

It is through Principal Financial, but somehow affiliated with Aetna as well... i dont really understand it...

But they gave me the run down on what is required in order to gain approval:

- History of Obesity for 3 years

- Current BMI and comorbities

- Psychological Visit (my surgical team requires that as well)

- Written plan for follow-up post surgery

- 6-12 month Physician supervised weightloss program

*Dietician visit every Month

*Physician visits every 3 months

*Documented exercise program

I'm feeling quite discouraged after all that. Mostly in regards to the 6 month diet. What exactly are they looking for? To see that you DONT lose weight with it? I'm concerned because I probably WOULD lose weight if I followed a strict diet and excercised all the time. The problem is that I would not be able to keep it off. I've lost between 20-50 pounds on 4 separate occaisions from dieting, but I always regain the weight I lost and then some. Should I just pretend I'm following the program but not really do it so I dont lose weight?

Also, I find it a bit ironic that they require monthly dietician visits, but those would not be covered under my plan. Any idea about how much that would cost me everytime?

[ksill18 0]

Dont feel discouraged. I had aetna and went though this. It all depends on your BMI now. Mine was 40.1 so they wanted me to just maintain during my 6 month diet monitoring which was easy to do.

[blondediva8 0]

My BMI is 41.5, so I definitely qualify that way.

Am I right in thinking that if you lose weight during this diet, then insurance will say that they won't cover the surgery becuase you proved that you can lose weight without it?

[Busybee424 0]

I had to do 6 months of visits with my PCP and basically its more to see that you are serious and going to take the surgery seriously. IF you lose weight they will not/cannot hold it against you AS LONG as you still meet the surgery requirements of having a high enough BMI and/or co-morbidities. Take the 6 months as seriously as you want. Personally I didn't diet at all, only because I knew after those 6 months I'd only have to jump thru some more hoops for the surgeon, which I did and that I took seriously and lost 21lbs before surgery.

[ParrotheadCathy 0]

Most people "try" enought to lose a couple or three pounds a month. That certainly won't remove you from qualifying physically for the surgery but will show that you "tried" under a medically supervised plan.

[adagray 1]

I know how you feel about the diet rqmt. I had been on Weight Watchers for 2.5 years already, but that didn't count since it wasn't doctor supervised. I thought the 6 month diet would be a waste of my time, but it actually has turned out to be quite worthwhile. I decided to do the 6 month weightloss through my bariatric surgeons office. The doctor/nutritionist knew that I could not lose much weight or my BMI would go to low so we worked on other habits rather than a strict diet. First, was to just do 10 min of exercise every day for a month, the next month my goal was to make sure I was getting at least 15-20 grams of lean Protein at every meal, this month I am working on decluttering/cleaning out my pantry and closet/wardrobe and reading 'does this clutter make my butt look fat' and carnie wilson's book 'still hungry'. I haven't lost any weight on the diet, but I feel like these things are helping me prepare for the changes to come w/surgery. I'm actually glad I'm doing the 6 month diet now and am thinking I really need therapy after the surgery to make the most of this. The psychologist didn't say I need it, but I can see now how much of this is psychological.