Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Question for Aetna Bandsters



Recommended Posts

Yesterday I just finished my final test before True Results sends my information to the insurance company. I completed the 3 month diet, all heart and pyschological testing and my 3 year medical information was submitted.

My question is this: Aetna says that unless you have a co-morbidity which I don't, you need to have a 40 plus BMI to qualify. Also, you must have that for the past three years. I'm unsure if I was over 40 BMI for ALL 3 years. More than likely I was at 40 for the last 2 years. What are my chances that I get approved? Has anybody been approved with having less than 40 BMI for any of their past 3 years? I'm so hoping to get good news but that really hurt to see that just because I wasn't morbidly obese for all three years, they would consider denying me.

Any help with this would be great. Thanks.

Share this post


Link to post
Share on other sites

Wow, well from the lack of responses this doesn't bode well for me.

Share this post


Link to post
Share on other sites

I was approved and banded June 10th.

My BMI was right at 40 (232 lbs) when I started this process in January and this was my heaviest weight. I did not have any weight documented for 2009 and my weight for 2008 & 2007 was 218. No co-morbidities until I was diagnosed with sleep apnea going thru the required appointments by Aetna.

I did the "fast track" 3 month plan - which really takes 5 months to complete. sleep study, pysch eval, 3 consecutive monthly appointments with nutritionist and 4 consecutive monthly appointments with weight loss doctor. Because I was right at BMI of 40 I was told not to lose or gain any weight.

Hang in there. Just go thru the requirements and see what happens.

Share this post


Link to post
Share on other sites

Well I have aetna and I was denied for that reason. So I went and had a sleep study done which showed I don't have sleep apnea. I guess that means I have no chance of appealing it. do anyone have any suggestions.

Share this post


Link to post
Share on other sites

I have my 1st appointment with True Results tomorrow. I went to my family doctor today and did not really tell my doctor what I was doing but she gave me a referral to the weight loss clinic anyway. I am with Aetna and my BMI is 37.

I am on blood pressure meds and heart meds for Cardiomyopathy.

I have problems with my feet, Morton's neuromas. I needto loose around 70lbs. I really hope that they will approve me. what do you think my chances are?

Edited by lv2bgoing

Share this post


Link to post
Share on other sites

I was approved and banded June 10th.

My BMI was right at 40 (232 lbs) when I started this process in January and this was my heaviest weight. I did not have any weight documented for 2009 and my weight for 2008 & 2007 was 218. No co-morbidities until I was diagnosed with sleep apnea going thru the required appointments by Aetna.

I did the "fast track" 3 month plan - which really takes 5 months to complete. sleep study, pysch eval, 3 consecutive monthly appointments with nutritionist and 4 consecutive monthly appointments with weight loss doctor. Because I was right at BMI of 40 I was told not to lose or gain any weight.

Hang in there. Just go thru the requirements and see what happens.

Thank you for responding. So it seems you did get approved because you in fact did have a co-morbidity with the sleep apnea. At True Results for my final appointment I was given a EPT test to see if I needed to be referred for sleep apnea. Apparently I didn't because the nutriotionist said the test went well. Since I don't have a co-morbidity then I'm worried I might get denied since I don't think my BMI was 40 or above for the past 3 years. I'm at 43 right now though. Ughh so frustrating!:)

Share this post


Link to post
Share on other sites

Well I have aetna and I was denied for that reason. So I went and had a sleep study done which showed I don't have sleep apnea. I guess that means I have no chance of appealing it. do anyone have any suggestions.

I'm sorry to hear you got denied. I'm in the same boat as you right now except I haven't been denied just yet. Still waiting to hear from True Results. I had my final appointment last Tuesday. I've started the pre-op diet. If I get denied this will seem to have been a waste of time. I leave it in God's hands. :)

Share this post


Link to post
Share on other sites

I have my 1st appointment with True Results tomorrow. I went to my family doctor today and did not really tell my doctor what I was doing but she gave me a referral to the weight loss clinic anyway. I am with Aetna and my BMI is 37.

I am on blood pressure meds and heart meds for Cardiomyopathy.

I have problems with my feet, Morton's neuromas. I needto loose around 70lbs. I really hope that they will approve me. what do you think my chances are?

I'm with True Results as well. It seems like you have an excellent chance to get approved. You have high blood pressure and your BMI is between 35 and 40. That makes you an excellent candidate. Good luck to you. You're in my prayers. :)

Share this post


Link to post
Share on other sites

Kentx05 thanks for your support and I hope I get the approval. Some one told me it would 4mo. but you said 3mo. hope it is 3mo to get approval.

Share this post


Link to post
Share on other sites

What is an EPT test?

I'm not absolutely sure it's called an EPT test or an EFT test. Either way, the test they gave me was to check to see if I had any airway obstruction. I had to breath in and out several times and such. I think I did well.

I wonder how long it takes True Results to send your info for insurance approval though. It's like watching the clock while you work out. :)

Share this post


Link to post
Share on other sites

I have absolutely wonderful news. By the grace of God I have been approved to have LapBand surgery. God is good. I am so happy about this. Obviously it's been a long road coming. Now I have to set up my pre-op appointment with True Results. Easier said than done. I couldn't get a hold of my Lapband advocate today so I'm still waiting to get the appoinment. God willing, I'll have surgery before school starts. :unsure:

Share this post


Link to post
Share on other sites

Yesterday I just finished my final test before True Results sends my information to the insurance company. I completed the 3 month diet, all heart and pyschological testing and my 3 year medical information was submitted.

My question is this: Aetna says that unless you have a co-morbidity which I don't, you need to have a 40 plus BMI to qualify. Also, you must have that for the past three years. I'm unsure if I was over 40 BMI for ALL 3 years. More than likely I was at 40 for the last 2 years. What are my chances that I get approved? Has anybody been approved with having less than 40 BMI for any of their past 3 years? I'm so hoping to get good news but that really hurt to see that just because I wasn't morbidly obese for all three years, they would consider denying me.

Any help with this would be great. Thanks.

Hi Ken,

Im a little late to reply but I went thru True Results and I also have Aetna and I was approved rather quickly with a BMI less than 40. But anyway congrats on your approval :unsure:. Advocate?? I NEVER MET my advocate.

Share this post


Link to post
Share on other sites

Hi Ken,

Im a little late to reply but I went thru True Results and I also have Aetna and I was approved rather quickly with a BMI less than 40. But anyway congrats on your approval :thumbup:. Advocate?? I NEVER MET my advocate.

Congratulations to you too. Wow, you were approved pretty fast. Have you gone to your pre-op visit? I'm hoping to go real soon. Do you know when your surgery will happen? I have no clue how booked they are with surgeries but I'm so hoping it'll be before mid August. My advocate wasn't really good with returning phonecalls but I made sure to stay on them.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×