Aetna approval without 2 year weight history?

[momx4goingthedistance 9]

Hi - had anyone been approved by Aetna without 2 year weight history showing BMI over 40? I am almost ready to submit but am so afraid of being denied. I have 1 year showing BMI of 36.2 from 2010 and a Jenny Craig paper from 2011 showing 38.3. Any advice is sooo appreciated ! I called the Bariatric nurse at Aetna 4 times over the last 3 months and she said not to worry- she said that since my BMI is 40.4- I should be approved with no problem . Is she lying?

[WOW101 54]

My secondary insurance is Aetna. They didn't give me hard time, but there were more hoops to jump through. My primary insurance didn't require as much and Aetna would not supplement the difference. My coordinator said that they are not difficult as long as you have the documentation. I think they wanted 2 years documentation, 3 nutritional classes, psych evaluation and if BMI is less than 40, a documented comorbidity.

[Sparklette 381]

Do you have any co-morbidities? Most insurances will do bmi of 35+ with diabetes, sleep ap, high blood pressure, pcos, etc.

[momx4goingthedistance 9]

Thank you for replying - I was just diagnosed with mild sleep apnea during this process. Do you think that would be enough? I just asked the YMCA for documents proving I've been a member since 2004. I used to work out there 5 days a week but then would get discouraged as I am now

[momx4goingthedistance 9]

My secondary insurance is Aetna. They didn't give me hard time' date=' but there were more hoops to jump through. My primary insurance didn't require as much and Aetna would not supplement the difference. My coordinator said that they are not difficult as long as you have the documentation. I think they wanted 2 years documentation, 3 nutritional classes, psych evaluation and if BMI is less than 40, a documented comorbidity.[/quote']

Thanks For the info - That's where I'm having the issue, with the 2 years documentation

[WOW101 54]

They just want documentation that you were basically overweight. Do you have records from your primary physician?

[Sparklette 381]

Thank you for replying - I was just diagnosed with mild sleep apnea during this process. Do you think that would be enough? I just asked the YMCA for documents proving I've been a member since 2004. I used to work out there 5 days a week but then would get discouraged as I am now

It depends, my insurance (BCBS) would qualify it with moderate to severe SA. I'd talk to your insurance.

[oldoneyoungagain 200]

Hi - had anyone been approved by Aetna without 2 year weight history showing BMI over 40? I am almost ready to submit but am so afraid of being denied. I have 1 year showing BMI of 36.2 from 2010 and a Jenny Craig paper from 2011 showing 38.3. Any advice is sooo appreciated ! I called the Bariatric nurse at Aetna 4 times over the last 3 months and she said not to worry- she said that since my BMI is 40.4- I should be approved with no problem . Is she lying?

I have Aetna and I only needed current six months of Weight Management, meaning being weighed in and discussion about managing your weight through Primary Care Physician. Psy evalu, and seeing a dietatian (once). At know time did they ask for the BMI prior to this six months. I had a BMI of 40 with hypertension, diabetes, and mild apnea. This was for a lap band, but talked with the nurse (band is coming out this month) and she basically said there wouldn't be any problem with Aetna with bypass, just have to go three more months of weight management this time and still qualify with a BMI 37. The doctors office was the only one that wanted to know how many times I had tried losing weight when I had the lap band. (Lifetime).