Approval Process - Aetna

[Guest]

Hi all,

For the past 2(ish) months I have been trying to get this entire process on a roll. But, I have encountered some obstacles. My BMI is (and has been for years) around 38. Most insurance companies require a BMI of 40+ or 35-39 with comorbidities. Currently, I dont have any comorbidities. Are there any options for me? I know I could gain the 15ish pounds to be over 40 BMI but, for my 5'1'' height 15 pounds is alot. Also, I believe my insurance (Aetna) requires 2 years of over a 40 BMI).I have been to one PCP and have expressed to her that I have sleep apnea (which I really don't) and rattled off to her some of my "symptoms". I'm trying to get just a clinical diagnosis for "my sleep apnea" and not have to go through the sleep studies which I know wouldn't reveal that I had sleep apnea. So, I guess I was wondering if anyone has any ideas on how to be a bit crafty or any suggestions on what I can do to get insurance to cover the procedure. Thanks.

[peatie 4]

Hmmm. To be honest, it sounds like a lot of 'fudging', if you know what i mean??

We're pretty similar. I'm 5'1 and my BMI is 36, but I was actually diagnosed w/sleep apnea via a sleep study (and I would have SWORN up and down I DID NOT have SA, so you never know!!!). I am able to fulfill all criteria as required by Aetna, but i'm still nervous they'll deny me. If you don't have any comorbidities or weight history over a 40 BMI consistently, I'm not sure they'll go for it.

My advice...have the actual sleep study done. It should be covered by insurance (mine was). You just NEVER know what might be the outcome!! And if you ARE diagnosed w/SA, you definitely qualify with less than a 40 BMI so it's worth a try!

Good Luck!!

[DougNichols 124]

but i'm still nervous they'll deny me.

From reading a billion posts on different forums, if you meet Aetna's requirements, they approve very fast, and reliably.

[Bryn 3]

same what peatie said. you may think you don't have sleep apnea, but you may.

i thought my snoring was just snoring. until i woke up tired and remained tired throughout the day. this was such a concern for me (being tired) that i went to my PCP and she recommended a sleep study to detect for sleep apnea. sure enough i had it; was pretty severe if i remember correctly. this was back in 2008, unfortunately i have to get another so i can get fitted for a c-pap machine. my old insurance didn't cover it.

but good luck to you. i would get a complete lab test from your PCP to detect if you have any co-morbidities as well (HTN, high cholesterol, borderline for diabetes, etc.) every little thing helps