Aetna question

[majorsmama 91]

Hi all. I have Aetna insurance and they recently changed the verbiage in the weight loss surgery requirements from a 2 year history of Obesity, to a "presence of persistent obesity". One of the requirements I have through my work is to get annual health assessments and in turn, I get $500 off my insurance premium. So my question is, would my weights taken FOR Aetna at these health screenings be acceptable documentation of my weight? I feel like it's a silly question and surely they would, but I have never been through this process before so I can't be certain.

Anyone know? I have my consultation with the surgeon on 1/7 and plan to call my insurance company in the near future, but thought I'd ask here too.

[samuelsmom 670]

It sounds perfectly reasonable to me. Records from doctor's visits also helps.

[baggyg0707 1]

My husband and I are with Aetna and our primary care doctor faxed our nurse coordinator our weight history. My surgery was completed 5 days ago and my husband goes on 12/29/14 !! All accepted by Aetna with no problems

[Joy889 11]

I have Aetna as well .. All they really want to know is documented weight from someone other than yourself. Im more than sure that is fine... .. you probably have to send them the documents though

[majorsmama 91]

Thanks everyone! I have doctors records from May 2013, but prior to that I had not seen a dr in a couple years. Odds are, with my 90-day diet I won't be getting the surgery prior to May, but in the case I can, I wanted to make sure I had a documented weight prior to May but the only one I have is from the health assessment from Aetna.

[TN_Gal 15]

I have this exact requirement with Aetna. I hate the lingo and can't figure out what persistent obesity means. Does that mean all medical records would need to show a bmi above 40 or just that you have been in the obese category? So confusing....

[majorsmama 91]

I have this exact requirement with Aetna. I hate the lingo and can't figure out what persistent obesity means. Does that mean all medical records would need to show a bmi above 40 or just that you have been in the obese category? So confusing....

I ended up speaking to Aetna and although they changed the verbiage, they are still looking for a 2 year weight history. That's what they told me they want when your surgeon's office submits for approval.

And the 40 BMI or 35 with co-morbidities applies. If you have no co-morbidities, then they want to see that your BMI has been over 40 for two years.

Edited January 13, 2015 by majorsmama

[TN_Gal 15]

Does the history have to come from a PCP? I think the only history I have is from sporadic obgyn visits.

[majorsmama 91]

It can come from any doctor. Ob/gyn, urgent care visits, etc.

[wildflowergirl 23]

I spoke with Aetna yesterday and was told as long as my BMI is over 40 NOW and I have two years of weight history being in the obese category then thats all I need. (I have been over a 35 BMI for years with no co-morbidities) I have doctor records showing my weight over 35 BMI for the last 5 plus years.