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

[BooCakes 0]

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

[spud.mama 7]

Hello! I am also doing the Aetna 3 month multi-dis. And I DO have to do the exercise. I have to do mine at the Cardiac Rehab, they have a community program here. My insurance lady said I couldn't do just the gym or curves cuz of the "physician supervised". I would call Aetna directly or have your lady clarify why you don't cuz you don't want to do 3 months of everything else then find out. Or just do it anyway to cover your butt.

Good Luck!!

[lindas0809 0]

I would definitely make sure because I have Aetna and was just approved on six month plan and it sounds like what you are doing. I only went to the Dr. monthly to discuss my diet & document my weight. My surgeon has a plan that covers the 3 month option and it is both exercise & diet( and extra money). I ask your Dr. if they have had other patients approved on the three month plan using the method they are doing. The last thing you want to do is submit and get denied because it's harder to get an appeal approved in the end.

Good Luck!

[BooCakes 0]

Yeah, I'm gonna get in touch and make sure. Your so right, I'll be real bummed to find out they were wrong or it was an oversight.

Linda, I will have like a total of 135 pounds to loose too. I have to loose 15 pounds pre-surgery.

[lindas0809 0]

Boo-

Good luck with everything! We have a lot loose but we can do it. Let me know how things progress for you. Feel free to email me with any questions.

Linda

[John337 2]

Boo - I'm also doing the 3 month program. YES - it must be supervised by your PCP, Nutrionist and exercise therapist or trainer.

I just finished seeing my PCP, Personal Trainer, Psych & Nutrionist once for 3 months. I had to keep a daily log of all exercise and a daily log of all food that I have consumed. All have written a report after each visit.

Monday I see my Surgeon to go over all paperwork and then they'll file everything with Aetna on Tueday.

To me, the 3 month program is worth it but it's a real pain in the ****. Documentation is the key........GOOD LUCK:thumbup:

[BooCakes 0]

Well, I don't have to do the physician supervised excercise program. I called and spoke with the patient coordinator and she laughed and for the third time told me "No". She said I am doing everything I need to for the 3 month program. She also said that my approval should go through pretty quick, and that they normally don't have problems with Aetna POS. I'm hoping she's right and I guess I'm just going on some faith her at this point. lol

As far as my PCP, they just need a referral letter and the weight history which shouldn't be a problem. I love my PCP and have already spoke with him.

I do have to do a nutrition program, which I had my first one Thursday. I have to see a nurse as well with each nutrition appointment. Don't ask me why? She said "your Aetna requires that". I have to do the Psych eval for my insurance and surgeon. I asked if I should be keeping or doing anything and she said they will handle all my records and submitting.

So, I'm a little nervous, but this is the third time I've asked and been told. They are a super busy program, so I am sure she knows what she is doing. She is really on the ball with it too. So, let's hope in 3-4 months your not all saying "I told you so!".

Thanks everyone though, I am glad I read your posts and called again today. I was just a little nervous and probably will be a little till I get approval.

JJ

[spud.mama 7]

I am with you Linda and Boo--I have 135 to lose also.

I wish I didn't have the exercise part to do otherwise I'd be done now!!! I started 2 weeks late and missed 3 weeks in March. So that puts me back to having to wait till June for surgery! Besides for blood tests which will only take a minute to do and getting my the sleep test done again but with the CPAP machine I am completely done with all insurance requirements. I wish I knew how you're getting around not having to do it.

[laurieanns 0]

Hi

I am doing the Aetna 3 month multi-disp approach w/ Aetna PPO too.... Thanks for the pointers you can bet that i will be asking if the exercise has to be documented and if anyone else has been "Aetna approved" on their particular hoop jumping plan.

I see the Nutritionist and Physician/Surgeon every time, I have also seen a Physical Therapist and a Psychologist for a one time visit..... Hmmmm.

Does this sound like you standard protocol to everyone else ??

They also have received the records from my primary physician for my weights....Their office submits all the paperwork. I have also given printouts of my "Daily Plate" to the Nutritionist for a general idea of what is going on with my exercise and eating. My final appointment is on April 28th, so hopefully that will go well and i will BE APPRoved!! ...:sad:

[lindas0809 0]

Laurie Ann-

Sounds like you are doing well - like everyone said documentation is the key. From my personal experience and what I've read on the boards Aetna is quick at approving if you've got all your documentation in. Mine was sent in March 23rd and I was approved by the 27th. I called the Aetna precertification line several times first to make sure they got everything and then just to check the status. I figure the surgeons offices are good at sending things (most of the time), but ultimately it's our responsibilty and no one else is as invested in it we are. For me the approval process was easier than getting a date for surgery - I'm hoping for June.

Spud mama- maybe our dates will be close. it would be great to talk to someone with similar weight loss goals and band dates. We'll keep our finger crossed for June(or May).

Good luck to all us Aetna bandsters!!

[letsgetitstarted 0]

Hi, I was approved by Aetna Pos II in early March. I did the 3 month supervised program that was put together by my doctors office. I was approved with no problems......I met first with the PA, Nutritionist, Psych, and Exercise Trainer, each gave me a regiment to do, but there was no follow up. Then had three group meetings with the Dietition, one of those sessions was with the Trainer, we had to turn in a food diary each session which also indicated what exercise we did. We also had a test the last session. So, if your doctor's office has a program that has been approved by Aetna then you should be home free. My doctor's office submitted my paperwork on day I reach the 3 month mark and I was approved 3 days later.

Good Luck.

[WDW Luver 0]

I have Aetna and am turning in my paperwork and having my official weigh in this next week. Do you get some sort of an approval from Aetna BEFORE you do the 3 mo program, and then the surgery approval after?

I ask because I have posted around here that I was about 5 pounds shy of 40 BMI when I went to the first weigh in. The dr office told me to (nudge, nudge, wink, wink) come back in a week or so and see if anything changed. I have been eating everything I can get my hands on and should be at the 40BMI next week.

But the info I have from Aetna seems to say that for them to approve me I needed to be at 40 BMI or 35 or over WITH comorbidities for 2 years prior. I have been over 35 BMI but no comorbidities (they apparently don't consider confined to a wheelchair due to severe feet problems to be a comorbidity :tt1: ) SO, I don't want to go through the expense and hassle of the 3 mo program just have Aetna say, oh sorry, you don't qualify so we won't pay.

Sorry, long rambling for a simple question--I am just so frustrated and not being able to get answers. Really I just need the answer to the bolded part!

[lindas0809 0]

WDW- You don't need to get approved before you do your three month program. You are taking it upon yourself to fulfill the requirements Aetna has set to get precertification. If you are worried that you don't meet the weight requirements and have no comorbidities I would ask to get a sleep apnea test done anyway.From what I have heard I lot of people get the test done and find out they have apnea (and get a comorbidity).

I know it's frustrating, but unless you are selfpay we've all been there. We are all jumping through hoops with no idea if they will approve us.

Good Luck!

[WDW Luver 0]

WDW- You don't need to get approved before you do your three month program. You are taking it upon yourself to fulfill the requirements Aetna has set to get precertification. If you are worried that you don't meet the weight requirements and have no comorbidities I would ask to get a sleep apnea test done anyway.From what I have heard I lot of people get the test done and find out they have apnea (and get a comorbidity).

I know it's frustrating, but unless you are selfpay we've all been there. We are all jumping through hoops with no idea if they will approve us.

Good Luck!

Darn. It seems silly that Aetna won't give you a preliminary okay before you go through the 3 mo program. If you go through all that and then get denied that is time and money wasted.

The way the Aetna rules read (to me) getting an apnea diagnosis now would do no good-- you have to have had the comorbidity for 2 years prior to approval.

[laurieanns 0]

Hi again,

I weighed myself at Bally's and it reports that i am up 2 pounds that i had lost!:biggrin: I weighed myself at home and am down 5 pounds total! :eek:

WHAt! ugh.... Usually my digi scale is 2 pounds lighter than Bally's scale. Ugh!

This is one bad word problem, anotherwords, my weight has stayed the same at the worst, and at the best i am down two pounds.:biggrin:

My last weight check is the 28th. I am seriously considering doubling my walking to five miles a day, and doing a protien shake twice a day w/ a lean cuisine in the evening! Does anyone know the weight requirements as far as Aetna is concerned for the 3 months, the doctor and nutritionist never gave me a ballpark or anything.... Thanks!:crying: