3 month multidisciplinary program requirement

[youkant4getme 0]

I am starting my third month today required for approval from aetna...unfortunately I have actually gained weight during this time. Does anyone know from experience if I would get denied if my md, nutritionist, and psychologist all gave me the green light? I know I wouldn't have been denied if I lost weight, but I didnt ask about gaining it, as I never expected that to happen. :blushing: And if I do get approved, how long does it take to get a surgery date? If anyone knows any of this, thank you in advance....I'm so nervous!

[Jodi73 11]

I have saw many posts on here where people have gained weight on their pre op diets. They were approved just fine! Aetna has a lot of hoops to jump thru, but if and when you do ALL of them, when you submit you should have a fast and positive answer.

Make sure to have all your ducks in a row BEFORE submitting, I think it cuts down on a lot of hassle.

I was just approved on the three month multi diet, and everything went very textbook.

if you have any questions, feel free to ask me!

Good luck!

Jodi

[youkant4getme 0]

Thanks so much for your info! I've completed 2 of my 3 months, and gained in both of those, but now I've stopped gaining. I'm DETERMINED I AM going to lose it before my last appointment 10.09.09! Congrats on being approved; I can't wait to know what that feels like! Do you know when you're being banded yet?

[melmarlem 0]

I have Aetna PPO. I also did the 3 month multidisciplinary program. I was one of those who actually GAINED weight during the 3 months. I was approved with no problems. Aetna has been WONDERFUL! I agree with the above post-Make sure you have everything they ask for when submitting. The insurance coordinator at my surgeon's office took care of sending everything to Aetna. It took me 5 days to get approval. Setting up a surgery date just depends on your surgeon. My surgeon wouldn't set a date until my last post-op visit with him. Good luck!

[melmarlem 0]

Oops. I meant last PRE-op appointment, not post-op! :sneaky:

[daqui26 4]

have aetna gained weight during 6 month diet, still approved

[youkant4getme 0]

Thank you guys for your information...definitely helping to calm my nerves! Have any of you got your surgery date yet? I'm still on cloud 9 knowing there is a light at the end of the tunnel, even with all the lifestyle changes that are going to have to take place. :blushing: I've got all my ducks in a row, and just waiting for my last appointment with my dr next month, and then it's just a week or two of waiting for a final answer! Good luck to everyone!

[Chasidy 0]

I've had two appointments with my surgeon so far - apparently the first one didn't count - but they said today that on Aetna I was able to do the 3 month program instead of 6 months. When you say have all your ducks in a row - can you give me an idea of what those ducks are? I'm a nervous wreck about the insurance. I don't want to get my hopes up for them to be crushed. I feel like the doctors office isn't telling me enough about the insurance because they know already. They did tell me today that it would be great if I did lose weight but it doesn't really matter at this point.

[Jodi73 11]

Aetna has a clinical policy bulletin on their website search by "cpb" then search by the alphebetical list for obesity surgery. This will give you exactly what you need to do to get approved. You will notice some of the requirements say "or by another qualified professional..." My PCP fulfilled those requirements for me, the only other professional I saw was a nutritionist, once, then two more times at two different classes. This was all documented by the ins coordinator when she submitted it. I will never really know if that worked for all three months of nutrition visits like some people did, or if you really only need to see them once. My coordinator and I both thought it read as you only needed one visit for the nutr. but...it is worded a little funny, and of course you will get different answers from Aetna, depending on who you talk to.

I hope this helps calm your fears, it may seem overwhelming at first, but I think its really all about compliance to a program. Plus, for me anyway, it has been a blessing to have accountability for my weight. It has helped me to loose 20 lbs. I would have never lost that weight without having to go weigh in every month, and thinking how it would feel to not have done well that month.

Feel free to ask me for more details, or anything else! We are all in the same boat, so I think any support we can give each other is great!

Good luck, Jodi