BG0103

I’m in a lot of Bariatric groups and there have been several who have gone through an in-network surgeon and have been denied and had to start over because they didn’t use an IOQ. I would call Aetna just to be clear in what their requirements are. Mine will only pay 70% if I don’t use and IOQ and I would have to do the 6 month nutrition. I know it’s clear as mud lol but you definitely want to know ahead of time!

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, 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.

It depends, is your surgeon an IOQ with Aetna? If so they will have the three month program. Aetna is very specific about IOQ’s and some policies will not cover at all if you use one that is not an IOQ. The 3 month is the fastest way. It typically comes out to 4 months. Your first meeting with the Bariatric team and then your first nutrition appt is typically scheduled after that.

The surgeon typically submits for approval to insurance once your three or six month nutritional visits have been completed along with any mandatory testing.

Wow, that was a super fast turnaround and great news for you! Congratulations! That alleviates my fears a little. there’s a woman in another bariatric group that I’m in that just had Aetna deny her claim because they wanted five years of her weight history instead of two. Isn’t it strange? I totally think it’s just up to the whim of the person reviewing it.

Best of luck, keep me posted. If everything works out for me I’m looking at a May surgery.

Thanks! Aetna clearly states 35 and over BMI but at only one time during the year would my weight have been under at a 34.8. The test or the reported weights that year are over 35 BMI. Of course I self reported as an inch taller than I actually am. I guess I seem taller to myself