Documented bmi for the last 2 years....Aetna insurance

[AbbieRoad 26]

I have Aetna HMO insurance and they do cover lap band surgery. The selection criteria says

"For adults age 18 years or older, presence of severe obesity that has persisted for at least the last 2 years (24 months), documented in contemporaneous clinical records, defined as any of the following:

1. Body mass index (BMI) (see appendix) exceeding 40; or

And here lies the problem for me. Though I have been overweight pretty much all my adult life...I very rarely go to doctors. I had been to the obgyn in January of 2009 weighing in at 325, and then not back in a doctors office until February 2011 weighing in at 375, and then again last week at 363.

Do you think they will count the OBGYN's weight documentation even though it's older than 2 years? I could go back farther than that and get my old obgyn's docs from 2006 when I was pregnant with my son, and also overweight (though closer to 275 then).

I've finally made the decision to get the lap band, I'm attending a seminar on June 7th and I'm really looking forward to this. I meet (and beat) he BMI requirement (at nearly 50bmi) but I'm worried because I've not really been an active doctor frequenter. I would really hate to have to wait 2 years since February to 2013 to get my weight records! Too bad pictures of my fat ass from those time periods couldn't suffice : /

Anybody have any idea? This is also my first posting here, been lurking for a few months. I'm 6' tall, 363lbs, size 26/28, 29 years old momma of 1.

Only other comobidities that I have is high blood pressure, high cholesterol...but the doc has recommended weight loss and that's it. No sleep apnea, that I know of!

Abbie

[mattie7632 24]

Well, you typed "presence of severe obesity that has persisted FOR AT LEAST two years, documented in......." So, I would say yes, based on that

I have Aetna HMO insurance and they do cover lap band surgery. The selection criteria says

"For adults age 18 years or older, presence of severe obesity that has persisted for at least the last 2 years (24 months), documented in contemporaneous clinical records, defined as any of the following:

1. Body mass index (BMI) (see appendix) exceeding 40; or

And here lies the problem for me. Though I have been overweight pretty much all my adult life...I very rarely go to doctors. I had been to the obgyn in January of 2009 weighing in at 325, and then not back in a doctors office until February 2011 weighing in at 375, and then again last week at 363.

Do you think they will count the OBGYN's weight documentation even though it's older than 2 years? I could go back farther than that and get my old obgyn's docs from 2006 when I was pregnant with my son, and also overweight (though closer to 275 then).

I've finally made the decision to get the lap band, I'm attending a seminar on June 7th and I'm really looking forward to this. I meet (and beat) he BMI requirement (at nearly 50bmi) but I'm worried because I've not really been an active doctor frequenter. I would really hate to have to wait 2 years since February to 2013 to get my weight records! Too bad pictures of my fat ass from those time periods couldn't suffice : /

Anybody have any idea? This is also my first posting here, been lurking for a few months. I'm 6' tall, 363lbs, size 26/28, 29 years old momma of 1.

Only other comobidities that I have is high blood pressure, high cholesterol...but the doc has recommended weight loss and that's it. No sleep apnea, that I know of!

Abbie

[alondralibre 0]

I have Aetna, and I was approved even though I didn't have any doctor's records for 2009. I went through True Results here in Dallas/Fort Worth, and the insurance coordinator used the medical records I had from 2007 and 2008. I think even an insurance company would consider it highly unlikely that I was morbidly obese in '07 and '08, dropped all the weight in '09 and gained it all back for 2010.

[AbbieRoad 26]

Oh good..... Yeah I'm hoping it's something where common sense would prevail...how can I be 363lbs now and 325 2 years ago...obviously I wasn't weighing in at 170 inbetween that!

But.....with red tape and corporations, you can never quite count on common sense! I get nervous!

Abbie

[Atsirc 10]

I also have Aetna and was afraid that they would not approve me for the same reason. I have an old doctor's office send in my charts (which did not discuss weight or weight loss). The charts only documented my weight. Once I completed the 3 month nutritionist/ primary care doctor assisted diet they approved me within 3 days! Good luck!

[mattie7632 24]

Yeah, isn't that the truth!!!

But.....with red tape and corporations, you can never quite count on common sense! I get nervous!

Abbie

[browneyedgirl89 10]

I have Aetna and i was worried about the same thing! I would NEVER go to the doctor because i was way too embarressed to be weighed in front of anyone. I weigh 300 now and the last time I had been to the doctor was in 2007 when i weighed 245 which put me right at a bmi of 40, did the 3 months of weight loss visits (even though i gained EVERY time) and was approved on friday and am scheduled for surgery june 10th! i am going through True Results in Houston and if you havent found a doctor yet, they really have been so great to me. My patient advocate Cindy is the sweetest lady ever and doesnt bullshit. she has gone above and beyond for me and really wants to do anything and everything she can to get the ball rolling.

[AbbieRoad 26]

Oh that makes me feel better! Thanks browneyedgirl! I ignored going to the doctor for the same reason....embarassment, and, I knew they would tell me to loose weight, which, I knew I had to do...just didn't want to face it kinda, ya know?

I'm going to a seminar on June 7th and will hopefully have things move quickly after that! Good luck with your journey!

[browneyedgirl89 10]

Good luck to you as well! Feel free to message me if you ever have anymore questions, I know I would always ask people a million questions in the waiting room.

[sweetpea61956 6]

I have had about the same here at True Results in San Antonio..they are awesome. Only thing is Aetna won't allow me to have the surgery at the True Results so I have to go to a hospital and the hospital requires and overnight stay. May 26th!!! is my surgery date.

[DaddyD 1]

My insurance is Aetna (through my wife's work) and once they finally got their act together in regards to admitting it was even covered (long story) then they said I needed to send them documented weight history for 2009 and 2010. This was just last week they finally asked, and my surgery date was supposed to be June 7th. Called up a clinic I went to in 2009 and was told it would be 2 weeks before they could send records. I was really crestfallen, because the only other time I'd been to the doctor and been weighed was in 2006. Luckily I was able to get that record sent in really quickly, and thank the Lord they accepted that as fulfilling whatever they needed to know. Had to move the surgery date (to the 21st) so I had time for pre-admission testing at the hospital, but 2 weeks late is WAY better than the "no surgery unless you pay for it yourself" situation I thought I was faced with.

[vickyd 24]

I'm sure you will be fine with your OB/GYN documentation. I have UHC and I had to provide 5 years of documented BMI...I was approved even though I had no documentation for years 3 and 4 but, like you, it would have been impossible for my weight to swing between 300 lbs to normal and back again in those 2 years.

[Debora Anne 3]

I too am going thru True Results in San Antonio - my insurance is not paying LONG STORY -June 8th surgery date YEAH~~~~~~~

I have had about the same here at True Results in San Antonio..they are awesome. Only thing is Aetna won't allow me to have the surgery at the True Results so I have to go to a hospital and the hospital requires and overnight stay. May 26th!!! is my surgery date.