Aetna- 3 Month Multi-Disciplinary Program (surgical prep)

[laurieanns 0]

Thanks for your reply Linda! :crying: I am calling the office tomorrow....

[Lady Lap Band 71]

I am doing the 3 month multi-discipliniary program through Aetna POS II. I've never had a problem at all with anything with my insurance and have my fingers crossed it stays that way.

The surgeon I am using is great and his office does ALL the paperwork, submitting etc. Which is nice on my end, I just have to show up to appointments.

So, to get to my point/question, it says a physician supervised diet and "Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional". My insurance contact told me I didn't have to do this. Yesterday was my first appointment with the nutritionist and I was told by her the same thing.

Did anyone else doing this particular program do or not have to do the "exercise regimen" and did you have any problems with approval?

Thanks so much!!!

JJ

I have Aetna, not that exact plan though and I did the 3month.....I got apprival very quickly and very easily.

[Jodi73 11]

Maybe its just me with some wishful thinking, but the way I read the Clinical Policy Buletin it says:

Excercise Regimen.....supervised by excercise therapist or other qualified professional.

Behavior Modification supervised by qualfied professional

Should your PCP not be a "qualified professional"? Mine documents my eating, excercise, behavior, everything...at my monthly visits. (I have had two so far) I have to bring in my food and excercise journals for her to look over, very detailed!

Only the reduced calorie diet program need to be supervised by an actual nutritonist or dietician. And...it doesn't say that you need to have three consecutive months documented with the nutrionist, just that you should be "supervised" by them and have a consultation. To me, it seems like the one visit my doctor requires with their nutrionist will suffice. Plus of course the monthly visits to your PCP.

Well, at the end of my three months, we will see I suppose! I will kick myself if I should be doing something now, and am not. I just can't afford a lot of this extra stuff! We have a max out of pocket of $2300, my hubby is already at his "limit" with that, if you know what I mean! I am sure to try and go see an "excercise professional" would cost a fortune! Yikes...

If anyone reads something differently in the CPB, or has other experience with this, let us know!

Good luck to all! Jodi

[Jodi73 11]

By the way, I have Aetna POS II. I have heard they are good about approving!

[laurieanns 0]

Hi

I am happy to report that at my last appt before submission of everything i was down a total of 7 pounds!

Now hopefully they will submit tomorrow and get a quick and positive response from Aetna :drool: !

I am thankful to this thread because i was able to ask all the questions

{ like have they ever had any aetna lap band candidates denied with their particular 3 month program}

and got the answers i wanted to hear.

Thanks again!

[WDW Luver 0]

I am being ultra CYA on this. I am seeing my PCP each month, seeing the nutritionist 3 times (once a month) and today signed up for some special group exercise classes at a local Weight Loss Center led by certified exercise trainers. I will do those once a week for the next 3 months. I am going to make a special "check off" sheet for the class leader to sign each week that I attend. The classes are designed for you to just attend once a week and then do the rest at home.

I am really hoping this covers all of my bases. My Drs. office doesn't have any experience with the 3 mo program. They are completely set up for the 6 mo. program. So they aren't really sure what needs to happen for this. The nutritionist does behavior mod as part of her meetings already.

[lindas0809 0]

laurieann- Good luck with submitting tomorrow! Let us know how it goes! The days will seem so long.....

[VividWoman 0]

Hello Fellow Bandsters to Be,

I am thrilled to say that I have been approved and will have surgery on May 5. I worked the 3 Month Aetna Plan. Please see my timeline below. I too was concerned about the exercise element and in fact, wrote to Aetna since phone calling did not provide additional insight to my question. Here was their response:

"Clinical Policy Bulletin #0157 states the exercise program must be physician-supervised and must be documented in your medical records every visit. You can exercise at a gym, although your physician is required to supervise your participation.

Sincerely,

Internet Response Team

Aetna"

So I joined Curves and made sure my Nutritionist recorded my visits. Long story short, I asked that they submit my case to Aetna 90 days from the date I saw my surgeon and a few days later I was approved! My doctor's office (they specialize in weight loss surgery) was unfamiliar with the 3 month plan but I did not let that deter me. I encourage you to follow all of the steps in the bulletin and stay positive.

I wish all of you luck as you wait for your approval.

[ahb08 0]

im so glad i found this post i too have aetna pos II and i have actually gained weight since my initial visit..im on the 90 day thing, but since i started and in dec 08 but skipped jan im having to do my final appt tomorrow.....but when i went to the initial visit on 12/21/08 i was 244 a bmi of exactly 40.0 so yea i aint gonna lie i knew that if i followed that 90 day thing with eating right and exercise daily i would loose and fall below 40 so i got on a "i will never get to eat like this again" binge and i have gained about 6lbs...since 12/31 to the present, which puts me at a bmi of 41 so im praying they approve me even with a slight weight gain in 4 mnths...and for the fact that i missed a month....but made it up by extending to april. Also my case mgr told me that aetna didnt require psych eval...that was up to the surgeon...i read on the aetna website that only if an individual has a history of psychological mishaps is when they would require a psych eval. and so far the surgeons office told me dr. marsden doesnt require it also.....so my last visit is tomorrow....and hopefully i will know something by 5/10/09!!