Aetna -3 month supervised plan

[yvette410 0]

Hi I am new to the website, I have attended a weight loss surgery seminar on 11/11 and have scheduled an appt with dietician for 11/17. My concern is to make sure I follow the requirements that Aetna has for approval. I called and spoke to rep regarding exercise regiman to confirm if I need to go through a exercise therapist of just have my pcp or dietician prepare a exercise program for me was told as long it is monitored by a qualified professional.

Can someone please give me advice on how to follow the 3 month program to prevent being denied.

My bmi is 43 also have diabetes and high blood pressure.

Any suggestions will be appreciated.:thumbup:

[sndycnrd 1]

The insurance coordinator at your doctors office will guide you. They have experience will all types of insurance. You don't have to figure it out by yourself - they will be happy to help you.

[yvette410 0]

Unfortunatly the insurance coordinator is not familiar with the 3 month plan only the 6 month supervised. I am going to contact Aetna again to get more info- this whole process is confusing. I don't want to make any mistakes and have to start the whole process over again.

[questions09 0]

I too did a 3 month supervised plan through AETNA. The insurance coordinator should really familiarize herself with this as that is her job!!!!! However- I had to do monthly nutritionist visits(at the weight loss surgery clinic) meet with the PA, have a psych consult, and then on the 4th month I met with the surgeon and he signed off on all the 3 month paperwork. It was then faxed to the insurance company and i waited for approval. It took about 2 1/2 weeks after that and i was approved.

Does your surgeons office have a nutritionist etc on staff?

The main thing I found was to work towards the goals that are set out for you through the nutritionist, make progress each month. The insurance company is looking not only at BMI, weight, and co-morbidities (like diabetes, sleep apnea etc), but that you are committed to making this tool work for you. message me any time- maybe I can answer some questions. However, the first step is to really get the insurance coordinator to work for you!!!!! Leslie:thumbup:

[yvette410 0]

Yes the weight loss clinic I go to has a nutrionist who I will be meeting and using since she is more familiar with what is needed. Did your nutrionist work with you for the exercise portion or do you go to someone else? Congrats on you results you are doing very well..Keep up the good work

[questions09 0]

Hey- the nutritionist did help me set goals for exercise.

In our sessions we set 2 food/eating goals and 1 exercise goal.

mine were: 1. stop drinking 30 min. before, during and 30 min. after meals.

2. cut out sugar- only eat sugar free treats

3. walk for 40 min. 3-5 times a week.

These were my last of the 3 month goals. We had built up to these over the 3 months.

My BMI was 40 and my only co-morbidity was high blood pressure.

Let me know if you have any other questions. Keep me posted on how things are going!!!!!!

[Irishbookworm 0]

Hi Yvette! I'm just wrapping up with the Aetna program and just got my surgery date this past Wednesday. I had contacted them initially to make sure that the surgery was covered and they put me through to a case worker that deals specifically with bariatric cases. She kept in touch with me throughout the whole 90 day program and made sure things were moving along. I would say to call Aetna and see if you can talk to a case worker there to discuss everything. I met with the psychologist 3 times, the dietician and the doctor 4 times. The dietician will help you set up some basic goals for exercise. They'll also get you looking at how things will be for your eating habits after the band (mine did at least) With the first meeting, she set some nutrition goals and some walking goals and then we followed up afterwards. I will say this, you may want to make sure to keep a food journal or something to take with you. It may help once your paperwork is submitted for approval if they can see some of what you're doing (I'm on sparkpeople.com and I track everything there and then print it and take it with me). Hope this helps and good luck! Hopefully Aetna can get you set up with a case worker. They were really helpful in explaining everything.

[yvette410 0]

Thank you so much for the info, this REALLY helps me. I will contact Aetna to speak with a case manager. I meet with the nutrionist(at the weight loss center) and my pcp on Tuesday. The gym that I go to also will print out each month my visits but I will keep a log of everything- to much documentation will not hurt. I am so excited and nervous. These next 3 months will fly by. Good luck to everybody. I defiantely will contact Aetna about speaking with a case manager because the customer rep that i speak to basically are reading back to me the same info that I have(they really don't have a clue). Thanks again and please keep me posted on your progress.:wink2: