Aetna - 2 year history of BMI

[nhandy 2]

Hey all! I am new here and am just getting started on this journey. I have been the a seminar and have my first appointment withe the surgeon and next Friday. I'm looking for advice and info regarding one of the requirements of my insurance company, Aetna.

They require a 2 year history of a BMI over 40. I have had a BMI over 40 for well over 2 years now. It currently is something like 48.6. My issue is, after my son was born in 2009, I didn't see a doctor until early 2013. My PCP moved to another practice and I couldn't get in to see her for a few years and I just wasn't sick at all so no need for an urgent care or anything. So I don't have a medically documented history of my BMI for the last 24 months. I have it documented from January 2013 till current, so 13 months.

Are there any records they will take in lieu of the medical history? I can submit photos and a link to a blog I created in 2012 when my weight was documented with photos of my weight on a scale. I can provide photos of my body for the last several years where I am clearly obese. I can provide a letter from my PCP stating that I've been obese for the entire time I've been her patient (10+ years). I just don't have that medically documented BMI history for the year 2012. I guess the worst case scenario is I wait another year and try to get approved then, but I would hate to stay fat for a whole other year. I want this surgery so bad!

Does anyone have any advice? Has anyone ever gotten approved through Aetna with missing this specific criteria?

[nhandy 2]

** sorry for all the typos lol. I'm posting from my phone.

[buddaflybeauty23 1]

I don't have Aetna nor do I know about missing medical records for that but I would def call ur insurance and speak to them about the questions you have and see what they say...

[gohelpyourself 377]

did you participate in Weight Watchers or any other programs where you were weighed in? These insurance companies are such a P.I.T.A!

[gohelpyourself 377]

I would ask your surgeons office before calling your insurance... you may say the wrong thing to the insurance... say too much. You do not want to say something that may give them any reason to deny your request for this surgery. Your surgeons billing staff prob know the ins and outs of all the insurance companies. I would hate for you to divulge too much to the insurance company and give them any reason to deny you. My insurance did not ask for that... they asked me to list all the diets I have tried in my life.

[nhandy 2]

I didn't have any weigh ins at all, anywhere, other than my scale at home. I don't really want to call the insurance company cause I have a feeling they will just flat out tell me no. They don't want to have to fork over the money for this surgery so I'm sure they would tell me I had to wait a year. I'm just hoping the surgeon I meet with has some sort of creative way of getting past this.

[nhandy 2]

I would ask your surgeons office before calling your insurance... you may say the wrong thing to the insurance... say too much. You do not want to say something that may give them any reason to deny your request for this surgery. Your surgeons billing staff prob know the ins and outs of all the insurance companies. I would hate for you to divulge too much to the insurance company and give them any reason to deny you. My insurance did not ask for that... they asked me to list all the diets I have tried in my life.

That's exactly what I'm thinking too. Thanks for the feedback.

[gohelpyourself 377]

http://wlsappeals.com/1182/walters_bariatric_surgery_blog/winning-bariatric-surgery-insurance-appeals/

this sounds hopeful!!!

[CrazyJaney 775]

I have Aetna and I go tomorrow for my LAST nut appointment. I can't remember if you have to have the documentation OR do the 6 months supervised. I have done the 3 month plan but I had to struggle to find documents from 2011. I did eventually but it's handwritten on a progress note. I'm afraid they might not accept it. I will scream bloody murder if I don't get approved. I'm a nurse and our insurance is Aetna through Vanderbilt University Medical Center. I'm having everything done at Vandy so I'm hoping this helps. I have been told many other Vandy nurses have been approved. If I find out something tomorrow at my appointment I will let you know. Keeping my fingers crossed for both of us!

[gohelpyourself 377]

I have Aetna and I go tomorrow for my LAST nut appointment. I can't remember if you have to have the documentation OR do the 6 months supervised. I have done the 3 month plan but I had to struggle to find documents from 2011. I did eventually but it's handwritten on a progress note. I'm afraid they might not accept it. I will scream bloody murder if I don't get approved. I'm a nurse and our insurance is Aetna through Vanderbilt University Medical Center. I'm having everything done at Vandy so I'm hoping this helps. I have been told many other Vandy nurses have been approved. If I find out something tomorrow at my appointment I will let you know. Keeping my fingers crossed for both of us!

Hi there: Being a nurse... doesn't your employer make you get annual physicals? They usually have height and weight documented on H&P.

[CrazyJaney 775]

Our wellness program started in 2012. We do now. The NP thinks it'll be ok but I'd like to hear it from the coordinator. I also had surgery in 2011 and I just now remembered that! It was at another facility. If worse comes to worst, I could get that H and P. Didn't even think about hospital records. Was just thinking about office visits. Thanks for shaking that out of me!