Question for Aetna Bandsters

[kentx05 3]

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.

[kentx05 3]

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

[MaggieB 6]

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.

[jprice332009 0]

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.

[lv2bgoing 0]

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 June 29, 2010 by lv2bgoing

[kentx05 3]

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!

[kentx05 3]

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.

[kentx05 3]

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.

[lv2bgoing 0]

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.

[MaggieB 6]

What is an EPT test?

[lv2bgoing 0]

What is an EPT test?

I believe it is a pregnancy test you get at the store.

[kentx05 3]

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.

[kentx05 3]

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.

[SwissMiss 1]

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 . Advocate?? I NEVER MET my advocate.

[kentx05 3]

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.