Aetna 2 Year Weight Loss History

[kimberlee1235 52]

Alright! I tried to search the forums for information specifically on this but I really couldn't find anything, so my apologies if this is repetitive!

I have Aetna. I've done my 90 days of documented registered dietician visits, which is outlined in the requirement of Clinical Policy Bulletin 157, and I've done my psych eval, I have a bmi of like 42...(I'm 5'4" and teeter-totter between 247 and 253, and i have for the past 4 yrs) My question is this: The part where you have to submit 24 months, or 2 years, of weight loss history....I went and picked up my records today from my previous doctors visits to take to my surgeon, and it only goes back to August 30th, 2010....so I only have 23 months. Prior to that I hadn't seen a doctor for a few months.

Has anyone had success for submitting close to 24 months of weight loss history but not QUITE 24 months? I'm just freaking out about a possible denial....I realize I could wait until the end of August but I really don't want to!

Please share your experiences with Aetna's policy on submitting the 24 month weight loss history.

Thanks in advance y'all!

[skboone1 1]

I have aetna and I definitely did not have 24 months of weight loss history. I only had the 6 months that they required. I got a letter from one of my other providers stating that I have been trying to lose weight for 2 years. It was like 2 paragraphs stating my bmi and height. my history of weight loss attempts and methods. I work for the providers office that is doing my surgery on August 28th. I got approved in less than a week. So at least get the doctor who is not the primary care to write a letter stating you been trying for 2 years. hope this helps.

[kimberlee1235 52]

Yeah I know you have to either do the 6 months or the 3 months supervised whateveryouwannacallit, but it also says you must provide a 2 year or 24 month history of prior office visits (not necessarily for weight loss...could be a cold, whatever) just as long as your weight was documented..at least that's what my surgeon says and it also says in Aetnas weight loss surgery guidelines

[IMSKINNY 160]

I don't have Aetna, but was told my ins uses the same guidelines. They accepted 3 office notes for 3 visits from each year. I didn't have to have a complete 24 months of visits. My PCP'S nurse chose the visits with the highest and lowest weight to show that had tried before.

[carolc 94]

I have Aetna and did not need a 2 year weight loss history, I did need 5 years of documented weight and a letter saying that I have tried unsuccesfully to lose weight. I had to go through my OBGYN because he is the only one that I saw every year. I only saw my PCP for illness and a random check-up here and there.

I hope that they won't hold you up for one missing month!

Best of luck!

[kw2walker 211]

I have Aetna and just submited my history. It was about 2 yrs off and on of my weigh history. My primary doctor also responded that I was pre-diabetic and prehpertensive and provided those extra records also. I too am nervous that I will be rejected for surgery. I will have my third of four required visits. Then its off to the nutritionst and psychologist.

I have read great tips, concerns, encouragements, success and failures on this site. I find it a very 'real' site. No sugar coating.

Thank you all and much continued success.

[kw2walker 211]

Well the date is set, July 22, 2013! I was so worried a year ago that the insurance company would be a problem. When it turned out to be one of the doctors.

I have to say the snag I experienced and got it resolved is how I knew I wanted the surgery, I fought! I called and called. I then wrote a letter and after 2 months the wheels started spinning again. All of that to say fight for what you want and need. Be your own advocate.

The program office worked with me and helped me make contact with the right people and here I am counting down the days until my surgery.

I welcome this new life change. To stay on the path I have been taking exercise classes 3 times a week and I'm currently looking to increase it to 4. I want to go into this surgery as strong as possible.

To everyone waiting for their date for surgery, I would say develop routines for exercise, chew your food in the smallest bites possible. Eat from smaller plates and remember you will enjoy some of the foods you do now but in much smaller quantities.

Continued success to everyone taking this journey!