Pls answer these ?'s for me about Aetna POS II & nutrition programs

[mpw09 0]

I went to see my PCP last week and they called me two days later to give me my appointment to attend the seminar at the bariatric center. I've heard that this is just an informational session and I will be scheduled to see a surgeon after this.

My insurance is Aetna POS II, and I've read in my plan that they will require either the 6-month supervised nutrition and exercise plan OR the 3-month surgical preparatory regimen for patients with a BMI over 40 with no co-morbids.

These are my questions: Does anybody familiar with Aetna know how they determine WHICH program you must complete? I called the insurance company and the rep wasn't much help.

Also, since the seminar is a month out, do you think I should ask my PCP to put me on a program NOW? I'd hate to waste this time. If the insurance co is going to require it (I've read that they will), then it seems like I should get started NOW.

Should my PCP be directing me on this? Or is it up the people at the bariatric center?

[WDW Luver 0]

I chose which plan I wanted to do. And I have been directing it myself!

I read the requirements carefully, searched for threads here to help me understand it and then set up all the appointments that I have needed and been keeping track of what I need.

I set up 3 months with the Nutritionist. I have had 4 visits with my PCP for weight checks, discussion on my eating and exercise and need for WLS.

Go and see your PCP NOW. Get it started. Discuss healthy diet and exercise and need for WLS. Get the head start so you have the documentation. Make sure they weigh you at each visit. Be sure there is about 30 days between each visit, and 90 days from the first visit to the last. Find a Nutritionist and set up 3 monthly appointement.

I am now waiting for the approval under the 3 month plan. But I am going to continue with another visit to the Nut and PCP in case I am denied. Then I am just in the 4th month of the 6 mo. plan.

Be proactive and take charge of what you need. Good luck!

[mpw09 0]

I chose which plan I wanted to do. And I have been directing it myself!

I read the requirements carefully, searched for threads here to help me understand it and then set up all the appointments that I have needed and been keeping track of what I need.

I set up 3 months with the Nutritionist. I have had 4 visits with my PCP for weight checks, discussion on my eating and exercise and need for WLS.

Go and see your PCP NOW. Get it started. Discuss healthy diet and exercise and need for WLS. Get the head start so you have the documentation. Make sure they weigh you at each visit. Be sure there is about 30 days between each visit, and 90 days from the first visit to the last. Find a Nutritionist and set up 3 monthly appointement.

I am now waiting for the approval under the 3 month plan. But I am going to continue with another visit to the Nut and PCP in case I am denied. Then I am just in the 4th month of the 6 mo. plan.

Be proactive and take charge of what you need. Good luck!

Thank you SOOOO much for responding to this!

I'm going to get on it right now. I saw my PCP last week and we talked about the need for the WLS. He wasn't surprised since (under his care) I've tried other diet plans with no permanent results in the past. He referred me to the bariatric center and set up the appointment for the seminar. But I was wondering what I needed to do in the meantime. So I will find a nutritionist and make another appointment to see my PCP in mid August. I appreciate your help so much. Thanks again!

[WDW Luver 0]

Thank you SOOOO much for responding to this!

I'm going to get on it right now. I saw my PCP last week and we talked about the need for the WLS. He wasn't surprised since (under his care) I've tried other diet plans with no permanent results in the past. He referred me to the bariatric center and set up the appointment for the seminar. But I was wondering what I needed to do in the meantime. So I will find a nutritionist and make another appointment to see my PCP in mid August. I appreciate your help so much. Thanks again!

Great! Mark that visit with your PCP as Day 1 and start counting 90 days. Make sure that you are including exercise in your 90 days and that your PCP is documenting it. That is the only thing I am concerned about with my approval. So far there hasn't really been any specific information from Aetna about what they expect for that part of the 3mo program so it is an unknown. If you see a personal trainer or do anything directly supervised for exercise then get some documentation. Make up a checklist for each date you go and have them sign each date or something like that.

I did my own exercise so my PCP just documented that in my notes each time. We will see if that works! I am the first one at my WLS office doing the 3 mo. program, so they have no idea how to do all this and what it requires. The Dr. asked me why I was doing the 3mo instead of the 6 mo. I told him "Why wait 6 mo, if I can do it in 3mo!!"

Good luck!!

[mpw09 0]

Great! Mark that visit with your PCP as Day 1 and start counting 90 days. Make sure that you are including exercise in your 90 days and that your PCP is documenting it. That is the only thing I am concerned about with my approval. So far there hasn't really been any specific information from Aetna about what they expect for that part of the 3mo program so it is an unknown. If you see a personal trainer or do anything directly supervised for exercise then get some documentation. Make up a checklist for each date you go and have them sign each date or something like that.

I did my own exercise so my PCP just documented that in my notes each time. We will see if that works! I am the first one at my WLS office doing the 3 mo. program, so they have no idea how to do all this and what it requires. The Dr. asked me why I was doing the 3mo instead of the 6 mo. I told him "Why wait 6 mo, if I can do it in 3mo!!"

Good luck!!

I just made an appointment with a dietician for this Saturday. She is very familiar with the process which REALLY made my day. She also told me that the exercise part of the 3-month plan is a big gray area with the insurance company (like you said). She is going to give me some info for an exercise physiologist when I see her. She said all of her patients have been approved that way. But she recommended that I call the insurance co to see if I can get more detail about what they want. She said some of her patients have seen physical therapists too and it worked out fine. Just as long as it's documented. I would think that if you are following a diet and exercise plan under the care of your PCP, along with the nutritionist, that would be enough. Keep me posted on your progress! Can't thank you enough for replying to my post.