Paperwrk sent to AETNA on 5/12, APPROVED on 5/13!!

[ahb08 0]

Hmmm I have Aetna QPOS...my BMI is like 40.1....i did all the steps..i am just worried that i lose a few pounds and my BMI goes under 40..I have proof of a gym membership but I havent gone because i dont want to lose more weight...do they check the times you go...or is a membership enough??

they wont check the gym..atleast mine didnt i didnt even join a gym i just told them what activity i did and they documented it on my charts....that seems to be the key in approval....make sure that the nurse practitioner or pcp is just documenting u making the efforts to change ur eating habits and that ur making the attempt to be active.....i just told my pcp tht i went walking like 4x's a week for 30 minutes....and provided the doc office a food diary stating everything i ate....i still had a bad food atleast once a week listed ont he diary but i made sure to show healthy eating habits on the diary mostly... these insurance loops are to see just how serious the patient is in loosing weight if they're considering paying thousands of dollars...if i were u if u want to be approved stick to the doc visits but dont go eating super healthy and exercising hardcore...just cut back on the bad things now that u will miss when banded...that will atleast help u maintain the 40 bmi....i was exactly 40 bmi and i actually put on weight just to make sure i dont go below....kinda regret it now cuz i went overboard on the weight gain......but hopefully i will have surgery in 2 weeks....

[jaredsdad 0]

Hi, new guy here. I have Aetna PPO and have been working with a bariatric surgeon since February.

On my first consult he told me that I needed proof of 6 months worth of visits to my PCP on weight loss for Aetna to approve me.

He gave me 6 sheets that the PCP can basically fill out, it has current weight, diet plan (calorie intake, etc) and excerise plan.

I have went every month since Feb (this month will be month 5) and my PCP is filling in what diet plan and exercise plan I've been on.

The bariactric surgeon said his office will submit all 6 forms (once I have all six) to Aetna for approval.

DOES THIS SOUND RIGHT? DOES IT SOUND CLOSE TO WHAT YOU THAT HAVE BEEN APPROVED THROUGH AETNA HAVE DONE?

In addition to the monthly visits to my PCP to fill out my form, I also had a consult with a nutritionist and a pyschologist.

PLEASE PROVIDE SOME INSIGHT FOR ME!!!!

5 months into this process...and the whole time wondering if Aetna will approve me!

Thanks

Jaredsdad

[adelarosa33 0]

they wont check the gym..atleast mine didnt i didnt even join a gym i just told them what activity i did and they documented it on my charts....that seems to be the key in approval....make sure that the nurse practitioner or pcp is just documenting u making the efforts to change ur eating habits and that ur making the attempt to be active.....i just told my pcp tht i went walking like 4x's a week for 30 minutes....and provided the doc office a food diary stating everything i ate....i still had a bad food atleast once a week listed ont he diary but i made sure to show healthy eating habits on the diary mostly... these insurance loops are to see just how serious the patient is in loosing weight if they're considering paying thousands of dollars...if i were u if u want to be approved stick to the doc visits but dont go eating super healthy and exercising hardcore...just cut back on the bad things now that u will miss when banded...that will atleast help u maintain the 40 bmi....i was exactly 40 bmi and i actually put on weight just to make sure i dont go below....kinda regret it now cuz i went overboard on the weight gain......but hopefully i will have surgery in 2 weeks....

Yea I gained 2 lbs. from my first visit to my second visit! lol...I feel like i have to...I'll try not to gain any weight for my 3rd visit June 18. I am so scared of not being approved after being so excited for this surgery! I'm keeping my fingers crossed!! Thanks for your help...and update me when you have a surgery date!!:redface:

[Huskergirl 0]

O.K. So I have called Aetna about 12 times to make sure I get things done the correct way. Sometimes I have to talk to member services and sometimes they refer me to precertification. Anyway, from what I understand (and believe me, I've written everything down), is that you see a nutritionist monthly for three months; have an exercise program that can be verified, meaning that they can print out all the times that you've gone (for example, I go to Curves), for a least three months; go to all the required "ologists" (psychologist, pulmonologist, and in my case, cardiologist); and then, all the information from those visits need to be sent to your surgeon. The surgeon sends all of that information in together to precertification with Aetna. Then Aetna makes the decision. I saw that someone had posted that they required you to see your surgeon every month, but I'm not aware of that requirement. So guess what? I'll be calling Aetna today and finding out that answer. Don't be afraid to call Aetna as many times as it takes to get the answers you need. Just like anything else, you're going to get those who really know and care and others who do not.

Sorry about the long post. Hope it helps a little.

[Mahaganie 0]

Your fine aetna don't check and see if you went to the gym they just want to see a statement showing your weight i actually gained weight

[youkant4getme 0]

I had an appt at a weight loss surgicial center to see if banding was the way I wanted to go on 06/11, and their office approved me. Aetna tells me theres no precert. dept I have to talk to; that I'll get a phone call from the office or Aetna once I'm approved or denied. That's fine, but they also told me they cant see anything about it until its approved or denied-that they don't have access to see it...Has anyone else heard this? I don't know if I can wait another 3 weeks to hear back! No one at Aetna can tell me anything and it's driving me crazy...