Anyone approved by Aetna with a lower BMI than 40?

[Sekeyi27 3]

I'm concerned because I'm currently doing the supervised diet for 4months and currently on month 3. My BMI is currently at 39 but I'm suppose to be losing weight. I'm thinking I may not get approved with the lower BMI and them wanting me to lose. So, has anyone been borderline and still was approved by Aetna?????

[MOMW 71]

I have Aetna and I had a similar experience to you. Do you have other comodalities like high blood pressure, high cholesterol, sleep apnea, diabetes? These make you eligible with a lower bmi. Also speak with your Bariatric team. My team submitted me for approval with my initial weight at my first visit. Check out the Aetna website or call them. I had a hard time finding it but it describes all the requirements for approval.

[Sekeyi27 3]

Thx, I have to do the sleep study test this month. They're currently running other test to see if I qualify besides my current BMI. I've called the insurance co and they were strict with the BMI. I hate to have gone thru this whole process just to be denied at the end. Hopefully, it works out.

[Sekeyi27 3]

Also, I initially was 40.1 when I was referred to see the bariatric surgeon and to attend a seminar but by the time I finally got an appt (3 months later) I had lost weight which made my BMI lower. So the bariatric team have me documented at the lower BMI for initial weigh in oppose to my pcp office. Really not sure how this will play out.

[The.new.g 48]

I have Aetna. Mine was a revision, band to sleeve. Their policy specifically states that to qualify for revision I needed to have had lost less than 50% EBW on prior WLS and it had to be more than 2 years prior. I fully qualified according to the policy but they denied me for being under a BMI of 40 anyway. We submitted appeals twice, the second appeal I was at BMI 40 and they approved it.

[MOMW 71]

Contact your Bariatric center and share your concern. I'm certain that they can help you to make sure you get approved. Good luck I understand your predicament.

[neekoal 37]

I was approved with a 37. But I think it's the employers plan that is the problem causer not Aetna itself. They all buy into different plans and have different rules. My doc said I was approved within 12 hours but 2 others he submitted to Aetna took 3 weeks to process because my employer was more supportive of bariatric surgery within their plan.

[Sekeyi27 3]

I was approved with a 37. But I think it's the employers plan that is the problem causer not Aetna itself. They all buy into different plans and have different rules. My doc said I was approved within 12 hours but 2 others he submitted to Aetna took 3 weeks to process because my employer was more supportive of bariatric surgery within their plan.

Thx, that's encouraging information. Either way, I'm still going to continue with this process and see what happens.