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How to Request Coverage
The first step in requesting coverage for either obesity surgery is to fill out the online questionnaire. The questionnaire asks about your current weight, medical history, and medications you currently take.
Aetna case management staff will then review your answers. You will be notified of the outcome within 14 days.
Letter of Acceptance
If your responses to the questionnaire meet the criteria for further evaluation, you will receive a letter of acceptance to the presurgical program. The letter will provide you with the phone number of an Aetna case manager to call so you can set up an appointment to go over your medical history and discuss the requirements of the program. If it is determined that you meet the requirements, you are required to submit documentation from your medical providers and begin to lose weight. You will have up to six months to lose five percent of your initial verified weight. Once the case manager has received all the required information and verified that you have met all the program requirements, your case will be sent to an Aetna medical director for review.
Center of Excellence Referral
If the Aetna medical director determines you have met all requirements, you will be referred to a Center of Excellence for further evaluation. These evaluations include a visit with a surgeon and a mental health specialist, as well as possible visits to a dietitian, nutritionist, or other specialists to ensure you have the best outcome possible. All care will be directed by your Aetna case manager and an Aetna medical director. The decision regarding which obesity surgery you have will be made by you and the surgeon at the designated Center of Excellence.
Medical Director’s Final Review
Once you have been evaluated at the Center of Excellence and it is determined that you are a candidate for surgery, your file will be reviewed again by an Aetna medical director, who will make the final determination whether obesity surgery will be covered.
You may apply to the program no more than once per calendar year. |
