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I am so confused!

kaclimer

By kaclimer, in Insurance & Financing

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kaclimer    0

kaclimer
Posted

I went to Dr. Hamn's seminar last week and saw him today for my consult. They gave me a sheet that told me what my insurance (Aetna HMO) required. It had all the usual (BMI of 35-40 or more, 6 month supervised diet, nutritional eval, psyc eval) but the part that is confusing is they said I needed to show the 'presence of severe obesity that has persisted for at least 5 years.' And that they need a copy of at least one office visit for each of the last 5 years that has my weight on it. Not a letter from the doctor saying I have been over weight, they need to see the actual medical records.

My problem--I have seen the doctor every year EXCEPT 2005! I saw them in 2001, 2002, 2003, 2004, 2006, and 2007.

My question--The official criteria on Aetna's website does not say I have to do that. It says 'Presence of severe obesity that has persisted for at least 5 years defined as any of the follow': BMI exceeding 40, or BMI greater than 35 with co-morbidities. I am wondering if I am going to be out of luck since I might not have consecutive years, or is that a rule the doctor requires to gather the information? For goodness sakes, I was obese in 2001, 2002, 2003, 2004 and 2006, one would reason that I would have been obese in 2005. :biggrin1:

Anyway...I was wondering if anyone else had to provide that kind of information. Especially with Aetna.

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AnnaB6    1

AnnaB6
Posted

Yes I know I also have Aetna POS and I can't seem to locate 2005 records I rarely go to the doctor. I think I have seen my obgyn more than I have seen my pcp. I hope everything goes well for you please keep me posted.

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Alexandra    55

Alexandra
Posted

That is not going to matter. If the last doctor note you had was back in 2000 it would be an issue, but you're totally good. You've got more medical backup than many people do!

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FurEllie    0

FurEllie
Posted

Yes I know I also have Aetna POS and I can't seem to locate 2005 records I rarely go to the doctor. I think I have seen my obgyn more than I have seen my pcp. I hope everything goes well for you please keep me posted.

Did your OB/GYN weigh you? Mine always does (darnit) and it seems like that would be proof enough you were overweight then.

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