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Aetna PPO Plan


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#1 peanoko

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Posted 13 November 2007 - 09:11 AM

Hello all. I have Aetna PPO and was wondering if anyone has that plan. I was just curious if anyone had any troubles with approval.

#2 Toony

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Posted 13 November 2007 - 09:39 AM

Hi, I have Aetna... my paperwork was submitted on Nov. 3, but who's calendar watching?

LOL! ME!

You will have to follow a 3 or 6 month plan... do you have the guidelines?

I'll try to find them and post here...

katie

EDIT: Found it

http://www.aetna.com...0_199/0157.html

Print this out and give a copy to the the secretary in your surgeon's office..... good luck!!!

#3 peanoko

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Posted 13 November 2007 - 09:47 AM

I was told I have to go through a 12 week program. I am a little concerned about my weight history. That is hard to get.
Good Luck to you Kate. As hard as it is good thing's are worth waiting for. I am sure everything will be fine.

#4 Debz

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Posted 13 November 2007 - 05:00 PM

I have Aetna PPO and they approved me no problem. There was a six month doctor supervised diet required, but I know they also have the three month multi-disciplinary track. For that, I think you have to see a doctor, a dietitian, and receive counseling for a three month period, but because I didn't do that, I'm not quite sure of the exact details.

I, surprisingly, found them extremely easy to deal with. They didn't even ask for my 5 year weight history, but I think that had something to do with the fact that I'm a diabetic. Good luck in your journey.

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#5 janine

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Posted 13 November 2007 - 09:18 PM

I had Aetna ppo...
They have 2 options...
I chose option 2..

Dr.'s letter of health prior to diet and recomendations for diet plan
3 months supervised diet by dietician
3 visits with nutricianist (once a month)
3 months of 3x week exercise plan (documented)
I chose the ymca because they log your visites
phsyciatric evaluation
dr's letter of health and recomendation letter from origional Dr.
5 years of documented weight by doctor (to show long term obesity)
There are other things I had to prove Like my bmi, high blood pressure, sleep apnia, border line diabetic, ect..

My doctor required:
Pulminolgist exam
cardiologist exam

After all this documentation I was approved within 2 weeks.

Sounds like alot and it is... They want you to prove it's necessary.

good luck!
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#6 shaxmom

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Posted 14 November 2007 - 10:28 AM

I had Aetna ppo...
They have 2 options...
I chose option 2..

Dr.'s letter of health prior to diet and recomendations for diet plan
3 months supervised diet by dietician
3 visits with nutricianist (once a month)
3 months of 3x week exercise plan (documented)
I chose the ymca because they log your visites
phsyciatric evaluation
dr's letter of health and recomendation letter from origional Dr.
5 years of documented weight by doctor (to show long term obesity)
There are other things I had to prove Like my bmi, high blood pressure, sleep apnia, border line diabetic, ect..

My doctor required:
Pulminolgist exam
cardiologist exam

After all this documentation I was approved within 2 weeks.

Sounds like alot and it is... They want you to prove it's necessary.

good luck!

Your insurance guidelines sould alot like mine. I am just starting this process and was given the outlines you listed. Is it realistic to think, if I get all the required documents together while doing the 3 month diet, surgery can be done before March 1?

#7 Toony

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Posted 14 November 2007 - 11:03 AM

Your doctor may have guidelines as well. Once I'm approved, I have to see him and the dietician... and follow a 2-week diet... depending on how booked up the appointments are, it could take awhile... Nothing is easy --- and waiting for approval and the surgery is time to spend reading, researching, changing habits and your lifestyle.

Best wishes!

#8 Jeri

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Posted 14 November 2007 - 01:36 PM

Or you could do what I did...which was lose all patience for the approval process and moan & complain about how long it took. :D Just kidding...it's a tough process & every surgeon & every insurance co is different. There's no way to know when your surgery date will be.

Your doctor may have guidelines as well. Once I'm approved, I have to see him and the dietician... and follow a 2-week diet... depending on how booked up the appointments are, it could take awhile... Nothing is easy --- and waiting for approval and the surgery is time to spend reading, researching, changing habits and your lifestyle.

Best wishes!


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#9 Ataraxia

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Posted 14 November 2007 - 01:47 PM

I have aetna PPO as well. I've been on dozens of diets in the past but none that meet their criteria so I'll be starting my 6 month medically supervised diet. I'm curious about the 3 month multidisciplinary criteria. I would much rather go 3 months instead of 6 months but the criteria concerns me. Afraid I'll do it wrong and it won't meet the standards that they are looking for. My other concern is that i'll actually lose some weight, not a lot but enough for me to no longer meet the criteria for the surgery. I'm on the low end of morbidly obese just a few pounds lower and I fear they will reject me once I lose any weight on the 6 month diet or they will reject me for not losing or gaining on the diet. My biggest fear right now is the insurance approval. I'd hate to get my hopes up only to get turned down. Even if I lose a little weight I'll still be obese and still at increased risk for disease but insurance companies seem to only care about some pre-defined criteria they come up with. Ironic thing is that I lose 15lbs before I had my first consultation. Oh well. What is meant to be will be. I'll fight for this because I deserve it. Keep me updated with your approval process it will be nice to go through this process with someone else.

#10 peanoko

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Posted 14 November 2007 - 03:44 PM

Hey all. I started my 12 week diet today. I am so excited. I have all of my appointments set and meet with the surgeon on Feb. 4, 2008. I was told my surgery will be the end of Feb. I found out the details for what I have to do for approval. I need to meet with the dietition and nurse practitioner 3 times (once a month) which I see both the same day. I also need a 5 year weight history and a letter from my PCP. I have to attened a support meeting. Then I need to take a test. Oh and see a psycologist and go for blood work. Sounds like alot but I already have alot of it done.
Everyone keep me posted on your progress and good luck to all.

#11 lynn

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Posted 14 November 2007 - 06:43 PM

i too have aetna ppo insurance. i followed the exact guidelines for the 6 month requirement and only had a weight history for 3 years. when all was submitted i was approved in 1 week.

#12 peanoko

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Posted 14 November 2007 - 07:03 PM

I have aetna PPO as well. I've been on dozens of diets in the past but none that meet their criteria so I'll be starting my 6 month medically supervised diet. I'm curious about the 3 month multidisciplinary criteria. I would much rather go 3 months instead of 6 months but the criteria concerns me. Afraid I'll do it wrong and it won't meet the standards that they are looking for. My other concern is that i'll actually lose some weight, not a lot but enough for me to no longer meet the criteria for the surgery. I'm on the low end of morbidly obese just a few pounds lower and I fear they will reject me once I lose any weight on the 6 month diet or they will reject me for not losing or gaining on the diet. My biggest fear right now is the insurance approval. I'd hate to get my hopes up only to get turned down. Even if I lose a little weight I'll still be obese and still at increased risk for disease but insurance companies seem to only care about some pre-defined criteria they come up with. Ironic thing is that I lose 15lbs before I had my first consultation. Oh well. What is meant to be will be. I'll fight for this because I deserve it. Keep me updated with your approval process it will be nice to go through this process with someone else.


I see your from Pa. If you don't mind my asking where in Pa? I myself live in Pa also.

#13 peanoko

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Posted 14 November 2007 - 07:11 PM

I have aetna PPO as well. I've been on dozens of diets in the past but none that meet their criteria so I'll be starting my 6 month medically supervised diet. I'm curious about the 3 month multidisciplinary criteria. I would much rather go 3 months instead of 6 months but the criteria concerns me. Afraid I'll do it wrong and it won't meet the standards that they are looking for. My other concern is that i'll actually lose some weight, not a lot but enough for me to no longer meet the criteria for the surgery. I'm on the low end of morbidly obese just a few pounds lower and I fear they will reject me once I lose any weight on the 6 month diet or they will reject me for not losing or gaining on the diet. My biggest fear right now is the insurance approval. I'd hate to get my hopes up only to get turned down. Even if I lose a little weight I'll still be obese and still at increased risk for disease but insurance companies seem to only care about some pre-defined criteria they come up with. Ironic thing is that I lose 15lbs before I had my first consultation. Oh well. What is meant to be will be. I'll fight for this because I deserve it. Keep me updated with your approval process it will be nice to go through this process with someone else.


For me I am going through a program that specailizes in weight loss surgery. I just need to do 12 weeks of diet and see a nurse practitioner once a month. Have a 5 year weight history, a letter of recomendation from my PCP, psych evaul, attend a support meeting, take some written test and go for blood work. You keep me posted as well.

#14 moosie

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Posted 15 November 2007 - 02:44 PM

I have Aetna PPO and was approved after 4 months and meeting their qualifications.
RNY July 31, 2007

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#15 Ataraxia

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Posted 16 November 2007 - 11:37 PM

I see your from Pa. If you don't mind my asking where in Pa? I myself live in Pa also.


Just outside the Philadelphia area. Work in Trenton, NJ. Where are you from?
Your plan sounds better than mine. I have to go twice as long and set up everything myself.
Maybe i'll try to meet every criteria of the 3 month plan, submit my pre-cert - continue with the diet and if I get denied just keep going til I finish the 6 month version.

#16 peanoko

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Posted 17 November 2007 - 07:58 AM

Just outside the Philadelphia area. Work in Trenton, NJ. Where are you from?
Your plan sounds better than mine. I have to go twice as long and set up everything myself.
Maybe i'll try to meet every criteria of the 3 month plan, submit my pre-cert - continue with the diet and if I get denied just keep going til I finish the 6 month version.


I am also right out side of Philly. I am about 10-15 minutes away from the new Philadelphia outlets if that gives you a better idea. I am doing only 3 month's because of where I am going. That's how they do it there if you have Aetna. This place only does weight loss surgeries and I am pretty much guaranteed approval now because I met all the criteria. Are you going through your primary doctor?

#17 Ataraxia

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Posted 17 November 2007 - 05:02 PM

I am also right out side of Philly. I am about 10-15 minutes away from the new Philadelphia outlets if that gives you a better idea. I am doing only 3 month's because of where I am going. That's how they do it there if you have Aetna. This place only does weight loss surgeries and I am pretty much guaranteed approval now because I met all the criteria. Are you going through your primary doctor?


I'm going through Barix Clinics, they only do weight loss surgeries as well but they don't offer any pre-surgery program that meets all of aetnas criteria. Plus they don't really start anything until they get pre-approval and I can't get pre-approval until I have either of those criteria fulfilled. I'm meeting with my primary for the doctor supervised diet portion though. Been playing phone tag with a dietician, still haven't got an appointment. I wish there was an easier way to do this. I'm a little concerned about the 5 year history of being significantly overweight. I know that I meet that criteria but I almost never went to my doctor when I was younger and obese. My mom has never been a fan of the medical system. I think my school nurse might have records of my weights but I dont' know if they keep those records that long. I graduated almost 8 years ago.

#18 peanoko

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Posted 17 November 2007 - 05:37 PM

I'm going through Barix Clinics, they only do weight loss surgeries as well but they don't offer any pre-surgery program that meets all of aetnas criteria. Plus they don't really start anything until they get pre-approval and I can't get pre-approval until I have either of those criteria fulfilled. I'm meeting with my primary for the doctor supervised diet portion though. Been playing phone tag with a dietician, still haven't got an appointment. I wish there was an easier way to do this. I'm a little concerned about the 5 year history of being significantly overweight. I know that I meet that criteria but I almost never went to my doctor when I was younger and obese. My mom has never been a fan of the medical system. I think my school nurse might have records of my weights but I dont' know if they keep those records that long. I graduated almost 8 years ago.


It's so weird how everyone does everything so differently. Where I am going they do everything there. I see the dietition and the nurse practitioner the same day I go there. They tell you where to go for your psych evaluation and I just have to attend one support group meeting. I myself am not big with going to the doctors but I alway's kept up with going to the gyno and that is where I got my weight history. Not sure if that helps you.

#19 patbunny

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Posted 17 November 2007 - 05:43 PM

Hi, my name is Pat...
I have Aetna (Select Plan) PPO and I was pleasantly surprised. I did go through the 6 month dietician supervised program, and then my paperwork was submitted in September 2007. In October, I received a denial because they needed a few more medical records to prove my 5 year history of morbid obesity. After submitting more records, my appeal was approved on November 6, and my surgery date is set for December 5th 2007. Good luck...!!! The waiting is the hardest part, and I tried to make the best of it by losing as much weight as I could on my own and making my lifestyle changes. You can do it....If I can, ANYBODY CAN...!!!!

#20 peanoko

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Posted 17 November 2007 - 06:08 PM

Hi, my name is Pat...
I have Aetna (Select Plan) PPO and I was pleasantly surprised. I did go through the 6 month dietician supervised program, and then my paperwork was submitted in September 2007. In October, I received a denial because they needed a few more medical records to prove my 5 year history of morbid obesity. After submitting more records, my appeal was approved on November 6, and my surgery date is set for December 5th 2007. Good luck...!!! The waiting is the hardest part, and I tried to make the best of it by losing as much weight as I could on my own and making my lifestyle changes. You can do it....If I can, ANYBODY CAN...!!!!


Hi Pat, how many dates exactly did you need? Or what exactly did you need for your weight history? Congrat's on the approval. Good Luck to you!