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Hi all, Ive been reading for a while,,,, went to the seminar last week,, they called me today to let me know what my insurance covers (aetna)   I have chosen to do the 3 month with the nutritionist plus 1 visit with physical therapy..  With in that 3 months,,, you can not gain any weight... so my question to anyone that may know,,, if I lose weight, can the insurance company come back and say "see you can lose weight, you dont need the surgery?  Silly question??

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I have aetna as well. My BMI was much higher than yours. I think I started at 47 but I was required to lose weight before surgery. I didn't lose much - maybe 20 pounds but lots of people here lost much more. I've never heard of anyone losing so much pre-op that their dr. or insurance said - you don't need surgery now. By the way, welcome to TT and there aren't any silly questions. Feel free to ask anything you want!

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Thank you so much,, I just wonder what the 3 month check in is for?  Another question for a fellow Aetna person... on my paperwork they emailed me today, it has some info ( I dont mind sharing)  Says specilasit office visit co-pay $25.00   Detuctable $500.- Not Met    Co Insurance 80/20  and out of pocker $2000.00- Not met...  what does all of that mean...

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A big part of the supervised pre-op portion of this journey is to document your commitment to this complete lifestyle change. It isn't to prove that you can lose weight - most of us have lost hundreds of pounds over the years. I think they are more focused on seeing if your head is in the game and you're really ready to make the changes you have to make to be successful at this.

 

ETA: every time you go to see the surgeon, you have a co-pay of $25. Your deductible of $500 means that the insurance will not start paying until you've paid $500. Your out of pocket max is $2000.00.

 

All of that means that it's going to cost you $2500.00 for surgery and then you're going to have to pay your normal co-pays for all of the visits prior to surgery because they aren't figured into the total.

Edited by Sleevarilla

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Says specilasit office visit co-pay $25.00 Detuctable $500.- Not Met Co Insurance 80/20 and out of pocker $2000.00- Not met... what does all of that mean...

It means you haven't been to the doctor a lot this year. ;) these are general insurance questions and not specific to Aetna. And Sleevarilla already answered. :)

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You should check your specific policy. Once my OOP max was met (in March!) I have zero responsibility and no more co-pay.

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they're typically just looking for you to show an effort to stick to a plan. I've had friends get denied for stupid stuff and others get put through without an issues (like me)

 

my nutrutionist didn't approve of the foods I was eating (even though I was actively losing weight). I went from eating like pizza hutt and kfc several times a week to making my own wheat crust pizza with healthy fresh ingredients and homemade baked "fried" chicken. but she saw fried chicken and pizza and turned off her mind. she actually wrote in her final referral to the surgeon (that gets submitted to the insurance company) that she didn't feel I was adequately prepared for the lifestyle,and I ended up getting approved anyway. so lord knows how they decide what to do. 

 

I'm 100lbs down and sticking to the diet just fine. part of me wants to approach her and rub it in, but she'd probably just thank herself for showing me the path so I'm better off just trying to forget about it. ;)

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Hi all, Ive been reading for a while,,,, went to the seminar last week,, they called me today to let me know what my insurance covers (aetna)   I have chosen to do the 3 month with the nutritionist plus 1 visit with physical therapy..  With in that 3 months,,, you can not gain any weight... so my question to anyone that may know,,, if I lose weight, can the insurance company come back and say "see you can lose weight, you dont need the surgery?  Silly question??

 

Hi!

I, too, have Aetna. You have to complete 3 whole months (so like 4) with a nutritionist. I'm not sure about the PT part but every plan is different.

They want to see that you're willing to make the lifestyle changes and will not penalize you. For me, I lost weight until the last month where I actually gained weight. When I lost weight, I was actually below the 40 BMI needed. However, even though I gained weight, I gained muscle. My NUT weighed me on a Tanita scale that showed overall fat, water consumption and so forth. 

 

I was petrified I was going to be denied but it all worked out and I was approved the first time. Also, Aetna has usually a pretty quick turn around time! 

 

Good luck on your adventure!

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