Janet B

Aetna's 3 or 6 month diet

10 posts in this topic

Posted (edited)

I have having trouble getting information on what Aetna wants for there pre op program. I don't have a copy of my insurance policy. My company tells me it's under legal review. I am unclear what they mean Aetna means by "qualified professional". They use these terms in the CBP 0157 in regards to behavior modifications and exercise regimen. Any one know what their definition is of qualitied professional means to Aetna?

Edited by Janet B

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Are you working with a bariatric center?  They usually have patient advocates who know all of the requirements.  It is likely that your insurance requires visits to a dietician/nutritionist as part of a supervised weight loss program pre-surgery.

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I didn't get notification you reply.  Thank you!  I am working with a bariatric center.  They are not very knowledgeable.  Their comments was we are not sure how to get approved in 90 days.  I have tried other bariatric centers and they don't seem to have patient advocates either.  I have a cousin that had surgery in Indiana and the bariatric center helped her with insurance requirements and pre op requirements.  I find it interesting that none of the centers in the Kansas City Area seem to have a pre op program.  I have been to my family doctor and she only seems to know how to get someone approved in 7 months.  I was told the first visit didn't count towards the 6 months which is another option to the 3 months. 

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That's too bad, Janet.  I guess it's all on you then.  Best buddy up to Aetna now.  Call them or go online with them to get a list of their requirements in writing.  I know you asked about a qualified professional.  What is the qualified professional needed for?  My guess is it refers to the supervised weight loss program.  My insurance (not Aetna) required 4 doctor/PA visits and 4 visits with dietician/nutritionist.  The visits had to be a certain number of days apart so I could be done in just under 4 months.  Hope this helps.

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Janet, I have Aetna too.

They have different requirements depending on which plan you have with them. Mine is a 3-4 month process where I have to be under a NUT's supervised diet plan with 4 meetings no more than 30 days apart, a exercise program supervised by a physical therapist - 2 meetings during the time frame of the NUT's meetings, plus a bunch of other tests, and a psych evaluation.

Your best bet is to contact Aetna and find out what is specifically required under your plan. I would also ask them if there is a preferred provider that they recommend in your area, if they are recommended by Aetna odds are they will be familiar with Aetna's process.

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13 hours ago, Havamal said:

Janet, I have Aetna too.

They have different requirements depending on which plan you have with them. Mine is a 3-4 month process where I have to be under a NUT's supervised diet plan with 4 meetings no more than 30 days apart, a exercise program supervised by a physical therapist - 2 meetings during the time frame of the NUT's meetings, plus a bunch of other tests, and a psych evaluation.

Your best bet is to contact Aetna and find out what is specifically required under your plan. I would also ask them if there is a preferred provider that they recommend in your area, if they are recommended by Aetna odds are they will be familiar with Aetna's process.

Perfect suggestion on provider.  They'll know what to do.

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On 3/21/2017 at 4:38 AM, Janet B said:

I have having trouble getting information on what Aetna wants for there pre op program. I don't have a copy of my insurance policy. My company tells me it's under legal review. I am unclear what they mean Aetna means by "qualified professional". They use these terms in the CBP 0157 in regards to behavior modifications and exercise regimen. Any one know what their definition is of qualitied professional means to Aetna?

 

16 hours ago, Havamal said:

Janet, I have Aetna too.

They have different requirements depending on which plan you have with them. Mine is a 3-4 month process where I have to be under a NUT's supervised diet plan with 4 meetings no more than 30 days apart, a exercise program supervised by a physical therapist - 2 meetings during the time frame of the NUT's meetings, plus a bunch of other tests, and a psych evaluation.

Your best bet is to contact Aetna and find out what is specifically required under your plan. I would also ask them if there is a preferred provider that they recommend in your area, if they are recommended by Aetna odds are they will be familiar with Aetna's process.

 

I agree with Havamal. Call Aetna, tell them what you want to do, and what Dr. you want to do it with. They will tell you whether that Dr. is covered under your plan, and what your expenses will be. They will also tell if your particular plan has any pre-op requirements, and what they are, and for how long.

Also, if you don't know yet WHO you want to use, and if Aetna doesn't have some preferred programs for you to check, seriously- do the research. Find out who your insurance works with, and then check them out as best you can. 

Let us know how it goes.

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Thanks for all the replies.  It has gotten a little more complicated.  My company changed to Aetna 1/1/17 and we are self fund.  Aetna is referring me to my employer to get a copy of the policy.  My employer is telling me the policy is still under legal review.  I only have a summary of procedures covered that includes a $10,000 bariatric lifetime max with no details.  At this point I am not sure I even have coverage.  I bet you all can relate to the fact this is a difficult process to get surgery approved.  I am determined and will keep trying.  Thanks again for your help!

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Good luck Janet!

Insurance companies can be daunting, but it will be worth it if you can get through the red tape.

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 Thank you for the words of encouragement. I know it will be worth it. Hopefully this diet time goes quickly. 

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