Aetna weight history

[peatie 4]

*added* What do the weights need to indicate? What if two are considered over a 35 BMI and one is about a 33 BMI? Do all the weights need to be 'within' their value (35+) ??

I moved 3000 miles just over a year ago, so don't have records from just one doc on weight history. I have something from my OB in Dec 08, Endocrinologist in June 09, and current PCP in Feb '10. Do you think just the face page copy of my visit indicating my weight is good enough for them?

Thanks for your help! :biggrin2:

april

Edited August 30, 2010 by peatie

[mrspalmour 0]

Good evening,

I also am having my surgery covered through Aetna. However I work for UnitedHealthcare and strangley enough my job for many years was reviewing insurance policies, medical records and determining if obesity surgery was covered so I am very familuar with what the insurance company is looking for. Now mind you I work for United and not Aetna but I also have read over the Aetna obesity policy closley and understand it. Anyway the weird thing is UnitedHealthcare does not cover obesity surgery for their employee's. Sad I know. My husband works for Bank of America and they do cover it for their employees and family....yay....I have been wanting this surgery forever. Ok not now for your question. As long as its medical notes and has a date and weight on it you should be fine with that you have. Nothing in that policy states it has to be from the same Doctor. Also the insurance coordinator at your surgeons office should be able to look at the records you have and tell you if they are suficient. I hope that helps and congradulations on your journy. I know you must be as excited as I am.

Michelle

[6kiddos 18]

Michelle -

What if you did not go into the doc in '09? For '08 I have my gyn appt, nothing for '09 (was thinking of taking my gym record taken by the trainer there monthly for 3-4 months and maybe a picture or two from that time). I have plenty for '10. Do you think this is sufficient??

don't mean to take over the thread but it relates. =)

[mrspalmour 0]

Well I really don't know if Aetna will accept that. I do know that UnitedHealthcare dosent. I don't feel its right but they don't. I would submit it and see what happens. Then if you need appeal. Contact your employer HR department and see if they would possibley do a benefit exception for your situation. The insurance company has to listen to the group as most of the time (If you work for a big or even medium company) the policy is ASO (administrative services only) and the insurance company is really playing with your employers money not theirs. I know in UHC it has to be medcaly documented weight history which means it has to be backed up by a medical professional. I hope this helps.

Michelle

[6kiddos 18]

thanks....I hope they take it. sigh. Btw, it is a personal plan...not through the employer.

[mrspalmour 0]

ok then it will be fully insured plan. It will be completely up to the insurance company. I hope they take all your information into consideration.

Michelle

[brandi622 0]

HI mrspalmour... I saw that your surgery is covered by Aetna. I have been looking everywhere to find out what health insurance plans Bank of America offers. I currently have Aetna insurance and am going through the 3 month plan for Roux en y approval, but I have been offered a job at BOA and I really want to take it but I wanted to find out if the surgery would be covered. Can you tell me anything additional about you husbands Bank of America Health Insurance??? Thank you!!!

[settebee 11]

6kiddos,

I thought maybe I could shed some light to your situation. I too have Aetna and didn't have weight history for 09, but I did have history for 07 and 08, but still wasn't good enough. Orignally I was denied, but I too sent in a gym record of my weight (I just asked the gym manager/trainer to type me a letter with my starting weight on their letterhead.) from 09, and 2 weeks later I was appoved! I hope this helps and you too get approved. I am sleeved Sept 20th!! Good luck to you!

Suzette

[6kiddos 18]

Suzette - I think I read about your situation. =) It is because of that that I have already gone to my gym. They photocopied the card they kept records on (about 4 weigh ins in 4 months) from last year. It has their letterhead on it and I have the receptionist sign it. Do you think I should do more...like from the manager? According to Aetna we only need 2 yrs history...so I am gathering '10, '09, '08. (I only have 1 appt for '08). Thanks for the encouragement. =)

[Hitorikiri 0]

Suzette, looks like my experience will be the same as yours then. I have weight histories for 07, 09, and 10, but nothing for 08 so I'm thinking at this point I will probably get denied. :w00t: The worst part is that I don't have anything to supplement the weight history for 08 so I'm really out of luck I think. *sigh* I'll probably have to wait until the summer of 2011 for an approval or self-pay if I can't wait.