Sorry to hear of your denial. I do the authorizations at Dr. Callery's office. Aetna is a tough company to deal with. As far as the 6 mo diet, there are a few ways you can go with that. 1. You can do the six months. You clearly have been seeing a physician while in work up for surgery. Depending on what the notes say from those visits, you can use those as part of your 6 mo diet. For example, if you started seeing your doctor in say, June, and he recorded advising you to work on pre-operative weight loss tha note can count as part of your diet, in which case you would already be 2 months into your 6 mo requirement. 2. You can do the three month mulit-disciplinary program which would consist of monthly visits with a psychologist, a nutritionist and an exercise therapist. 3. You can tell Aetna that your diet is ongoing and will be completed before any surgery date is planned. It is in their policy that surgery can be approved before completion of the 6 mo diet as long as it is completed before surgery.
The weight history is a little trickier. I have had patients approved without ever sending in officicial drs notes. I have had people approved that only made a chart of their weight loss, not even approved by a physician. I have also had people denied that provided everything that was requested. Unfortunately its kind of unpredictable. Its as if your apporval just depends on the person that ends up reviewing it. I think seeing your Dr. to inquire about a letter of support is a good thing. I also think that writting a letter in your own words regarding your struggle with weight loss and the other problems your excess weight is causing you would be helpful. You mentioned that the drs. notes that were submitted were of a lower weight because of dieting. You should point that out in your letter. Mention that due to dieting your weight had dropped, but the weight was re-gained. It would be best that the appeal come from your surgeons office so they can re-send all of your records, if they are willing to do it. I know some offices do not deal with appeals. If they don't, get a copy of all of your records from them to submit yourself with your letter.
Lastly, The January 2010 date on your letter was most likely the expiration date that the auth would have had if it were approved. Aetna uses that as the date of service when the service isn't actually scheduled yet.