Insight for Aetna?

[VSGFATBOTTOMGIRL 0]

This is so stressful. My surgeon's office is submitting my stuff to insurance today. The thing is, Aetna requires a BMI of 40 for 24 months to prove a history of obesity. I have weights from June 2012, and all of 2013, obviously 2014, and one weight from a gallbladder surgery in January of 2011 which was when I was having gallbladder attacks and not eating--- putting me at 38.8 BMI (7/8 pounds away from 40). This is from 3 years ago, so i don't know why they need it but my surgeon's office wants to include it. I'm really freaking out and I don't know if they will approve me or not. Anyone have this issue and get approval?

[rbtnln 81]

I didn't have this issue, but I do have Aetna. If you call them, you can go on line and they show you their guidelines for approving bariatric surgery. The fact is, your surgeon should be providing them with all of the information they need to make the right decision. If you just had a brief period of time where you lost weight and it was due to a medical illness, I can't see that disqualifying you. If you did it through diet and exercise they might think, "Well, she can obviously lose the weight and be successful without surgery." That wasn't the case with you. Call them and talk to a counselor. See if there's any information they can give you. They won't tell you "Yes" over the phone, but they can reassure you of what you need to be approved. I've had 2 lap bands and the sleeve approved through Aetna. No issues to my knowledge. Good luck! Hang in there!

[spraine 14]

I was declined by Aetna for the same reason...I did not have a BMI of over 40 for 24 consecutive months (though it sounds like yours was >24 months). I felt like I was being punished for trying to lose weight on my own. My appeal was unsuccessful, so ultimately, I opted to pay out of pocket. I did my surgery in my hometown, though it cost about 3x what a trip to Mexico would have cost. I am a health care professional and just could not wrap my brain around Medical Tourism. I am too big of a chicken.