Aetna and co-morbidity

[micphd 7]

I can't get a straight answer - I have fluctuated between 37-40.5 BMI. Currently undergoing testing for sleep apnea. Does anyone have aetna and clarify if they require your comorbidities to be documented for 2 years or just the weight? Meaning if I fluctuate over 2 years of having a bmi above 35 but just recently diagnosed with sleep apnea will I be denied?

[FRED1977 186]

I thought I was going to be denied because the clinic I went through to do my testing at called True Results in Texas stated that my BMI had changed through out the years and they were not sure I could be approved. What you have to go by for your BMI is your current BMI and compare it to what the govt says should be your ideal weight. This would also help to get you the surgery if you are within the govt guidelines of obese. All you can do is try because according to True Results I didn't meet all Aetna's guidelines and I was approved on my first submit.

Good luck.

[kw2walker 211]

I can't get a straight answer - I have fluctuated between 37-40.5 BMI. Currently undergoing testing for sleep apnea. Does anyone have aetna and clarify if they require your comorbidities to be documented for 2 years or just the weight? Meaning if I fluctuate over 2 years of having a bmi above 35 but just recently diagnosed with sleep apnea will I be denied?

What's your blood pressure looking like as well as your A1C? They look at all of those.

For me my blood pressure, A1C, weight (up and down), then sleep apnea and I had a thyroid issue all worked in my favor for the approval process.

The sleep apnea sealed the deal with atena.

BMI may play a factor not sure how much, but a history of it going up and down could work in that it shows you have been trying but have not been successful with maintaining a lower weight.

[Sweet_Mia 61]

I can't get a straight answer - I have fluctuated between 37-40.5 BMI. Currently undergoing testing for sleep apnea. Does anyone have aetna and clarify if they require your comorbidities to be documented for 2 years or just the weight? Meaning if I fluctuate over 2 years of having a bmi above 35 but just recently diagnosed with sleep apnea will I be denied?

Hello,

I have atena and I had to do a 3 months of weight management, & 3 months nutrition , get a EGD to check to see if I had a hernia, psych evaluation, sleep study. After all those appointments I found out I have sleep apnea and now I sleep with a cpap machine, I also have a hail hernia. The paper work was submitted but atena needed more information. Aetna wanted a 2 year documented weight history to show proof I was over weight. One the doctors office submitted what aetna was asking for I got approved.

This is what I went through. Don't give up or get discouraged you may not have to go through what I did. Best of luck in everything. Take care.

PS. You can always call your insurance yourself to check and see what the requirements are for wls.

My New Journey 2013. SD 7-30-13

[micphd 7]

Thank you for the replies. I know the requirements my insurance (aetna) requires. They just aren't clear on comorbidities And whether they need a 2 year history or not.

[Jamie Greatone Jamison 19]

I don't know that a 2 year history is required with Aetna. I have sleep apnea. They told my surgeon's office that I would have to complete a 6 month doctor supervised weight loss program before getting approved. A few weeks later, my surgeon's office called me to tell me that Aetna had approved me and that I could get the surgery now. My BMI was over 50 though, so that could have played into it. I think it honestly depends on who you talk to at Aetna because obviously, in my case, 2 different people gave 2 different answers when my surgeon's office called for approval.

[kj44 215]

Also have Aetna and had the two plus yr history. Did the 4 spots with nut. The scope down throat asleep study and was sleeved in April only thing with Aetna is while approved and have met deductibles and my yearly max out of pocket ....still keep getting bills for more and more things they didn't pay down. Very frustrating