Really Nervous After 2Nd Visit And Insurance Coverage

[TexasSoccerMom 26]

I have aetma and they do cover WLS. The problem now is I have sleep apenea, but it is really mild. Other than high cholesterol and history of DVTs, I have no other comorbidities. So we are going with BMI over 40. Well at my first visit, my BMI was 39.9 (I had of course been trying another diet). Today, my BMI was 40.1. My problem is around 2010, I was doing sugar busters and had lost 10-15 pounds. So when they got my medical records from my Primary Care doctor and my GYN, my BMI in 2010 is too low. They have told me they are going to submit my 2009 and 2011 weights and say they couldn't find documentation for 2010. Anyone else's doctors offices do this? My insurance advocate told me not to worry, but I am.

[Ajai 0]

That's odd that they're going back 3yrs like that. I'm in NY and have HIP health coverage. I only had to document the past 6 months of weight loss attempts before my visit to the bariatric Dr and my primary Dr wrote a letter stating how I've been struggling with weight since he's been treating me. Try looking on my Dr's website www.newyorkbariatrics.com Dr Vohra and Dr Nishimura are the equivalent of medical twins. They are always on the same accord and you receive top notch care from them and their staff. I'm not saying cone to NY to use them. All I'm saying is look at the website and call their office if you have questions. They will answer your questions even if you're not a patient. Now that's good business in my book.

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[Cocoabean 430]

I have aetma and they do cover WLS. The problem now is I have sleep apenea, but it is really mild. Other than high cholesterol and history of DVTs, I have no other comorbidities. So we are going with BMI over 40. Well at my first visit, my BMI was 39.9 (I had of course been trying another diet). Today, my BMI was 40.1. My problem is around 2010, I was doing sugar busters and had lost 10-15 pounds. So when they got my medical records from my Primary Care doctor and my GYN, my BMI in 2010 is too low. They have told me they are going to submit my 2009 and 2011 weights and say they couldn't find documentation for 2010. Anyone else's doctors offices do this? My insurance advocate told me not to worry, but I am.

I have heard of insurance companies accepting non-consecutive years as proof. What does AETNA's policy say? Does it say 3 years of history of obesity? Or history of obesity over the last 3 consecutive years?

[Mrs. Curtis 42]

Surgery center I went to said that insurance asked for 1 recorded weight from a previous doctor for the past three years- I didnt go to the doctor in 2010 so they just submitted the paper work with 2009 and 2011 and everything was fine. When I called the insurance about that and asked if it would prevent me from having surgery they were not aware of that being a requirement. Was confused but thought maybe it was the doctors office just trying to cover all bases at once but was approved and now about 3 weeks post op.

I would just recommend that if you have questions to call your insurance and verify what is required that way you have the knowledge