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Aetna Questions


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After starting the process almost 3 years ago and then bailing due to husband's sudden health issue I find myself here again. 

I'm back to considering the VSG. My insurance covers it (Aetna) but I'm reading stories of people being denied because their weight history has an occurrence of a BMI under 35 in the past 24 months That would be August 2018 for me 

After putting off surgery my Dr. put me on Vyvanse. It worked for a while and at one weigh in my BMI reported at 34.8. Problem is, I self-reported my height all of these years and I'm actually an inch shorter than I thought I was so I guess that's water under the bridge. If I had let the Dr. measure me I never would have been under 35 BMI. I have sleep apnea and use a CPAP. 

Has anyone been denied because of this? I mean, the weight came right back at the next 3 month checkup. I stopped the meds and am now at my highest weight. 

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I do not know about Aetna's rules, but my insurer only required me to state that I had tried several weight loss methods and that in the long term none of them resulted in me losing weight and keeping it off.  If you call the customer service line for your Aetna health plan, you should be able to request a copy of the plan's guidelines for when weight loss surgery is covered.

Although VSG is an excellent weight loss surgery, be sure that you understand all of the benefits and risks of both of the two popular weight loss surgeries - VSG and RNY gastric bypass - as it may prove that a gastric bypass is better suited to your current medical conditions, etc. 

For many of us (including me) my only regret about weight loss surgery is that I did not have it sooner.

We are here to support you.

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  • 1 year later...

I too have Aetna. My requirements are BMI 40 or above. 6 month program with my PCP (must show I’m attempting to lose weight through Atkins, weight watchers..etc 2 year weight history, sleep apnea screening, cardiac clearance, attend a support group, psych evaluation, and a nutrition class (2)

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