SandraVA30

Ok, here is my dilemma - I am in the process of completing the 3 month multi program that Aetna requires. Part of their requirement is having a BMI over 40 (or 35 with co-morbities which I don't have) for the previous 2 years. My BMI is way over 40. Ok, so this is where it gets kind of tricky for me. I originally was going to start this process at the end of last year but was afraid they wouldn't approve me due to my BMI in 2006. I am a yo-yo dieter and in 2006 ONLY I had a normal BMI. Every other year it has been over 40. (That whole thing irritates me, I think they should look at OVERALL history, not just 2 years) Anyway...so now it's 2009 and I will be submitting for pre-approval at the beginning of March probably. Do you think submitting my weight history for 2007 and 2008 will be ok or do you think they will ask for 2006? And do the specific dates in 2007 and 2008 matter or just anytime during the year. I am just not sure how picky they are. If they ask for 2006 I am pretty much screwed. And what exactly do they want with "weight history" in terms of documents? The insurance coordinator at my surgeon's office says they just need a date and weight on letterhead from the doctor, not my entire medical records. In your experience, is that enough? I guess if worse comes to worse I will have to wait longer to submit for approval, but since it's 2009, I am thinking that technically they won't ask for 2006. Any thoughts/suggestions?

usairdebw

I have similar problem and have been denied twice and am in the appeals process. I have BMI just over 35 and sleep apnea.....but I have only been 35 for 2 of the past 4 years and because of that I have been denied. I also am a yo-yo dieter and was down at different times. My sleep apnea caused me to lose my job last year.....but fortunately my union helped me get my job back. In order to keep my job I have had to switch departments for a later shift and a sedentary job. None of this is helpful......I have 2nd level grievance hearing with BC BS on January 22.

I wish you well.......
Deb

__________________
highest weight/day of surgery/current/goal
240/233/145/150....maybe 140
LAP RNY February 16, 2009
height 5'9"

co-morbids/sleep apnea/pre-diabetes

loki8481

I was approved pretty easily by Aetna... all I submitted for my weight history was a physical from my primary care physician from this year (well, last year... Sept. 08) along with the records from a physical he gave me when I was starting college in 1999.

__________________
~Alan


goal #1: 225 pounds (my weight freshman year of high school) -- reached on 9/13/09
goal #2: onderville (199) -- reached on 11/19/09
goal #3: normal BMI (173) -- reached on 2/27/10

Milestones:

12/04: pre-op diet start (406)
12/18: surgery (383)
04/11: twoterville! (299)
11/19: onederland! (199)

Native2u

I have also had problems with Aetna: see the thread under "insurance" titled...."Here we go again".

I'm also a yo-yo dieter and have been for many, many years.

I got fed-up with Aetna and decided to hire an Attorney to help me fight this fight...I'm over it!

iamsuzen

I was approved by aetna after jumping through a few hoops. However, they really werent too bad. My husband's approval was a few weeks behind mine, and his was apporved with no denial at all.

__________________
Susan - soon to be half the woman I am now!!

Current: 5'3" 213
Highest 320
Lost 107 since surgery 1-20-09

sheepla

I think I can help as I am also insured by Aetna and also wouldn't qualify if I had to provide a weight history prior to 2007. I met with the surgeon and patient care coordinator last week. The page they gave me of what I had to provide specifically stated that I need to provide them with doctor notes that showed my weight for any time in 2007 and 2008 and that day's visit to the surgeon would be my 2009/current weight. You should have to provide anything from 2006. I haven't been approved yet but they do this all the time and have an exceptionally high first time approval rate so I do feel like they know what they are doing.

Hope that helps.

__________________
10/15/08-appt with PCP-full blessing to proceed
10/27/08-begin 3 month supervised diet
11/10/08-attended surgery seminar
12/1/08-sleep study - no sleep apnea
1/6/09-first appt with surgeon
1/23/09-psych evaluation scheduled
1/30/09-upper encoscopy scheduled
2/3/09-complete 3 month supervised diet
3/3/09-documents sent for insurance appoval
3/23/09-APPROVED
4/27/09-pre op surgeon visit
5/20/09-surgery scheduled

Native2u

I have had Aetna for 2 years now and they have been pretty difficult to deal with (sometimes....depending on the situation). In my case, I've had to hire an Attorney to fight to "have" Lap RNY so that I can regain my health back. Since they have denied me, I have been diagnosed with Diabetes type 2 and I'm currently fighting daily with my blood sugars (even on a strict diet). I have submitted SO much paperwork to Aetna and each time I feel that they aren't even reading my case/chart records (that is based on the fact that they show that they have all of my records on one day and then they deny me the next....I have proof of that).

Bottom line with Aetna is.....it all depends on who reads your case & if they truly read your case, as to whether you will get an approval or not.