Your Aetna experience?

lonestar5212 · 03-07-2008, 02:05 PM

JUDBO414- Thanks. And good luck to you with your surgery. It is coming very soon!!! Mine is the 14th and I am still in shock I think. A little nervous, but ready to go. Keep us updated on your husband.

tmarie07 · 03-07-2008, 02:15 PM

Lonestar - where is Aetna requiring Dr Marsden to do the surgery? Mine was the Lewisville Surgery Center.

Tina

lonestar5212 · 03-07-2008, 04:06 PM

They have approved Hurst. I wish it was Lewisville, I live very close. Surprised me because Hurst was not on my list in DocFind, but that is what Dr. Marsden's office told me.

tmarie07 · 03-07-2008, 05:33 PM

My letter of approval from Aetna had the location on the approval letter, I actually had to tell Dr Marsdens office which one it was, as they hadnt recieved it sp they made a copy of my letter (I think their gal that handles that might not have forwarded it to his Hurst office with my file info). The Hurst Surgery Center is suppossed to be excellent, so I'm sure you'll be fine! It'll just mean a little longer drive home, but you'll be so medicated it wont really matter!

Tina

annesan · 03-09-2008, 05:21 PM

I'm wondering why alot of you are doing the 6month "diet" and not the 3 month surgical prep plan diet? Isnt it close to being the same? I am on week 3 of the 3 month diet. It is medically supervised by the surgeon. I go in 2x a month to be weighed and the nutritionist put me on an 800 cal a day diet( I guess that is part of the difference- its a "very low ca diet instead of low cal diet. I have to figure out though about how to prove the exercise part and the behavior mod- I emailed my surgeon and the insurance and the center today as I have been thinking about that.
Anne

**MacMadame** · 03-09-2008, 07:22 PM

Some insurance companies require a 6 month medically supervised diet and won't accept the 3 month version. Mine let's me chose, thank goodness.

jenniferann6 · 03-10-2008, 12:12 AM

I know everyone has mixed feelings of Aetna, I've been a member for 8 years and have always paid in, just haven't used them for any thing major other than having babies or Dr. visits.

I did the 3 month diet, had all my ducks in a row and my Dr's office submitted everything on the 28th of Feb, on March 6-six days later, I was called from my Dr.'s office and told that I was approved for surgery on March 28th.

I'm excited and have waited for a long time for this day. Good luck to everyone! Hang in there, it goes quick!

annesan · 03-10-2008, 12:25 AM

Jennifer,

If you don't mind sharing, what did you have to do for your 3 month. I am on a 3 month 800 cal a day diet,.I meet with the surgeons office 2x a month to weigh and document. I am still trying to figure out what they will need to prove the exercise component and behavioral modification. I emailed my surgeon and the insurance at the office today to ask. I talk regularily with the dieticain and talked with the therapist the same day I had a consult.

Anne

jenniferann6 · 03-10-2008, 12:50 AM

Anne,

To begin, I went to a seminar at a Dr's office that pretty much specializes in Lap Band. 3 month program consisted of an 1800 calorie a day diet, which was supervised by a nutritionist, recommended by the dr. office. Each visit was $75; she was also the exercise "component" . Everything I ate/drank had to be documented, and what food group it was so that I could take a glance at it and the Dr. and nutritionist could too; and see what food groups I was eating and what I needed more or less of. Exercise was walking at least 30 mnutes a day, and that too had to be written down. Within 5 days of visiting the nutritionist, I also had to visit my PCP for them to weight me and review my diet/exercise log. IT IS VERY IMPORTANT FOR THE PCP TO WRITE THIS DOWN WHEN YOU VISIT, THAT THEY'VE REVIEWED YOUR DIET EXERCISE LOG AND TO CONTINUE ON IT! AND

jenniferann6 · 03-10-2008, 12:57 AM

Anne,

To begin, I went to a seminar at a Dr's office that pretty much specializes in Lap Band. 3 month program consisted of an 1800 calorie a day diet, which was supervised by a nutritionist, recommended by the dr. office. Each visit was $75; I had to go every 30 days, 4 visits in all; she was also the exercise "component" . Everything I ate/drank had to be documented, and what food group it was so that I could take a glance at it and the Dr. and nutritionist could too; and see what food groups I was eating and what I needed more or less of. Exercise was walking at least 30 mnutes a day, and that too had to be written down. Within 5 days of visiting the nutritionist, I also had to visit my PCP (4 visits in all) for them to weigh me and review my diet/exercise log. IT IS VERY IMPORTANT FOR THE PCP TO WRITE THIS DOWN WHEN YOU VISIT, THAT THEY'VE REVIEWED YOUR DIET EXERCISE LOG AND TO CONTINUE ON IT! AND THEY ALSO HAVE TO WEIGH YOU AND WRITE IT! That was done for 90 days-Nov. 15 thru Feb 15 which was a few more days then 90, but I didn't want to give the ins. company any reason to deny me. I had to have a psyc. evaluation which was $175, she was also referred by the dr.'s office. A 5 year weight history which I think with Aetna has now been changed to 2 year history. I basically had a check list provided to me from the dr. office and I followed it down. And here I am.....

dogluvr · 03-10-2008, 11:26 PM

Still waiting *sigh*

NeNe967 · 03-11-2008, 08:57 AM

Quote:

Originally Posted by dogluvr

Still waiting *sigh*

I'm still waiting too. I found out yesterday that Aetna had no record of my appeal that was supposedly sent in February and now they just resent it Friday, March 6. I am a little disappointed with my doctors office because this is a two-week set back for me. I know I am not the first Aetna appeal they've done so they should know the fax number to the Appeals Department. I had to provide them with a phone number. Go figure...

lonestar5212 · 03-11-2008, 03:42 PM

dogluvr - Remember, it took 4 weeks but I was approved. Hang in there, it will come for you. Remember also, if you meet the criteria, you have nothing to worry about. Sometimes it just takes longer for some of us.

lonestar5212 · 03-11-2008, 03:47 PM

NeNe - I feel your pain. I hate stories where the process is messed up because someone doesn't take care of business, and there you sit with no power, at their mercy. That kind of stuff made me insane. I bet the reason they took 4 weeks for me was because someone neglected to pass something on, or whatever, in a timely manner. Just keep positive and your day will come.

NeNe967 · 03-11-2008, 03:51 PM

Thanks for the encouraging notes...it really does make things better having a support group.

I'll keep you guys posted on my progress.

Sincerely,
NeNe