P2P Call Guide

How to Win a P2P Call for Bariatric Surgery Denied by Aetna

Payer-specific strategy, medical necessity arguments, and the exact phrases to use when Aetna denies Bariatric Surgery (CPT 43775, 43644, 43846).

Why Aetna Denies Bariatric Surgery

BMI does not meet threshold

Supervised weight loss program not completed

Psychological evaluation not documented

Comorbidities not adequately documented

Know Aetna's Criteria

Aetna uses their own Clinical Policy Bulletins (CPBs) and InterQual criteria. CPBs are publicly available and numbered.

Key policies to know:

  • Clinical Policy Bulletins (CPBs) are publicly available and numbered
  • Uses eviCore for radiology and cardiology prior auth
  • Known for detailed, evidence-based CPBs with specific criteria
  • Precertification list updated annually

Aetna's Specific Approach to Bariatric Surgery

Applicable Policy

Aetna CPB 0157 (Obesity Surgery)

How Aetna Typically Denies This

Aetna CPB 0157 is very specific: BMI >= 40, or >= 35 with comorbidities. Requires 6 months supervised weight loss in a multidisciplinary program. Also requires medical clearance, psychological evaluation, and nutritional counseling.

Your Strategy for This Payer

Aetna's 6-month requirement is non-negotiable. Ensure every month is documented. They also require the program to be multidisciplinary -- dietitian, psychologist, and physician involvement must all be documented.

Key Phrase to Use on the Call

"Per CPB 0157, the patient has completed a 6-month multidisciplinary weight management program with documented [monthly weights, dietary counseling, behavioral therapy] and has a BMI of [X] with [comorbidities]."

Building Your Medical Necessity Argument

Document BMI >= 40 or BMI >= 35 with comorbidities

Show completion of 3-6 month supervised weight loss program

Include psychological clearance and nutritional evaluation

List comorbidities with supporting clinical data (A1c, BP, sleep study)

P2P Call Tips for Aetna

Reference the specific CPB number and criteria being met

Aetna CPBs are very detailed -- read them before the call

Address each specific criterion in the CPB during the P2P

Aetna medical directors are typically receptive to guideline-based arguments

Guidelines to Reference

  • ASMBS/IFSO Guidelines for Bariatric Surgery
  • NIH Consensus Statement on Bariatric Surgery

Relevant CPT Codes

CPT 43775CPT 43644CPT 43846

Specialty: General Surgery

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