Don't want to gain weight & then be denied!

[longer-life 139]

Hi everyone!

I fear gaining 10-12 pounds and then being denied by my insurance (Aetna PPO).

I have had a BMI around 38 for decades with a few months of 40+ throughout the years. This is when I would join Weight Watchers & yo-yo. I don't have their booklets, however I can access my info on their website and perhaps print it out. Hopefully my doctors can find a visit or two with a 40+ BMI. I don't have co-morbities.

At what point during the process is the official weighing & measuring done? Should I go to orientations & then meet someone from the surgeons office that I pick? I would like to show my proof of obesity to someone, so they can tell me what my chances are BEFORE gaining the weight.

I need your suggestions!!!!!

[former_vbg 198]

I had my sleeve using Aetna PPO. If you look at their policy bulletin, that should be your guide. You will need to show 2 or more years of a 40 or higher BMI. If you want to read their bulletin, just go to the Aetna site and type in "Vertical Sleeve policy bulletin" and it will take you to their bulletin.

So, if you can get the documentation for when you were 40+ BMI the past 2 years you should be ok.

Hi everyone!

I fear gaining 10-12 pounds and then being denied by my insurance (Aetna PPO).

I have had a BMI around 38 for decades with a few months of 40+ throughout the years. This is when I would join Weight Watchers & yo-yo. I don't have their booklets, however I can access my info on their website and perhaps print it out. Hopefully my doctors can find a visit or two with a 40+ BMI. I don't have co-morbities.

At what point during the process is the official weighing & measuring done? Should I go to orientations & then meet someone from the surgeons office that I pick? I would like to show my proof of obesity to someone, so they can tell me what my chances are BEFORE gaining the weight.

I need your suggestions!!!!!

[longer-life 139]

Thanks for your reply. I have been to their website and read it. I might have misinterpreted it.

I have NOT been 40+ for 2 years. I have been obese for a lifetime but only 40+ for a few months before joining Weight Watchers and going back down a bit. I would now gain 10 pounds to once again be 40+.

Do I not meet the requirement?

[former_vbg 198]

Unfortunately I don't think so. Either 2plus years of 40plus BMI or 35 with 2 or more co-morbidities. I think that stinks because for people that are borderline, it just delays the indevible (sp?).

Thanks for your reply. I have been to their website and read it. I might have misinterpreted it.

I have NOT been 40+ for 2 years. I have been obese for a lifetime but only 40+ for a few months before joining Weight Watchers and going back down a bit. I would now gain 10 pounds to once again be 40+.

Do I not meet the requirement?

[longer-life 139]

Wow, if you are correct, I am being punished for trying to lose weight. Had I stayed at 40+ then I would be approved! That's depressing. I am going back and reading it. Hopefully others can chime in with their experiences. Thanks again.

[tlong 0]

I wanted to know the answer to the same question. When I went to my consultation I weighed 226 on their scales which would put me about 40 BMI. Then the girl told me that they take off 4 pounds for clothes and shoes! Let's just think about this.....I live in Texas and it is hotter than haddes here. I had on a pair of shorts, tshirt, and flip-flops. I argued with the girl to give me my 4 pounds back because I did NOT have on 4 lbs. of clothes. It was the difference of a 39 BMI vs. 40 BMI. It was quite comical!!

Wow, if you are correct, I am being punished for trying to lose weight. Had I stayed at 40+ then I would be approved! That's depressing. I am going back and reading it. Hopefully others can chime in with their experiences. Thanks again.

[longer-life 139]

tlong she cheated you! It does say EXCEEDING BMI of 40. I wonder if you can gain a pound or two, wear heavy clothing & go back.

@ former VBG, you are correct. It states we have to be over 40 BMI for over two years. I snore like crazy. Now I hope I have sleep apnea.

I wanted to know the answer to the same question. When I went to my consultation I weighed 226 on their scales which would put me about 40 BMI. Then the girl told me that they take off 4 pounds for clothes and shoes! Let's just think about this.....I live in Texas and it is hotter than haddes here. I had on a pair of shorts, tshirt, and flip-flops. I argued with the girl to give me my 4 pounds back because I did NOT have on 4 lbs. of clothes. It was the difference of a 39 BMI vs. 40 BMI. It was quite comical!!

[medmgr 4]

Wear heavy clothing w/ steel toe boots, iphone in your pocket, keys, any thing else you have w/ some weight... good luck!

[MeMeMEEE 206]

I read someone put on ankle weights

[iegal 460]

Okay, I was a self payer. You are in the questionable zone. Go into see your primary doc and see what/he or she says about you having a couple of comorbitities. Go to a free weight loss seminar if your surgeon of choice has one. Work with the financial office and see what they say. Trust me, your surgeon wants to perform surgery to help you.

Um, wear a lot of clothes too. The initial weigh in is your starting weight. Also, they ask your height. Slouch when they measure you. Good luck.

[suez1105 2]

What if your weight/BMI for 2009 was 37 with no co-morbidities at the time, but now your BMI is 40 and have sleep Apnea, high BP and Cholesterol? That is the same concerns I have. I am afraid I will be denied. The insurance person at my surgeons office just told me to hope I have sleep apnea, so I am hoping that overrules the rest. Thank goodness they just diagnosed me with it on Monday night. Now we shall see.

[tlong 0]

Depends on your insurance. Most insurance companies want two co-morbidities for BMI of 35-39. If you have a 40 BMI most insurances do not require 2 comorbidities.

What if your weight/BMI for 2009 was 37 with no co-morbidities at the time, but now your BMI is 40 and have sleep Apnea, high BP and Cholesterol? That is the same concerns I have. I am afraid I will be denied. The insurance person at my surgeons office just told me to hope I have sleep apnea, so I am hoping that overrules the rest. Thank goodness they just diagnosed me with it on Monday night. Now we shall see.