Aetna H. M. O. So Cal - Advice

[Loss78 50]

Hi all, I'm new to the sight and am looking for anybody who has Aetna H. M. O. And possibly from SoCal. I have my primary care physician on board, met with the NUT and she approved, had my psych evaluation and she approved, I am 36 and 225 lbs. (at my heaviest I was 245lbs.) I am pre-diabetic and have high cholesterol (not on meds for either at this time, but have been in the past). I had my sleep study and do not need the cpap machine but was told that when I hit the REM sleep in the early morning hours I stop breathing 8 x's an hour and to solve that I will need to lose weight. So my question is this, for anybody who has this insurance, how hard was it for approval? Has anybody had a similar situation as me? I am currently waiting to hear from my Doc to set up the appointment with the surgeon.... So any advice while I'm playing the waiting game would be very much appreciated! Thanks!

[mcclayne 36]

You said weight but not height/bmi

That's a big factor

I have Aetna. And less pre complications with my health than you and got qualified! I am 19 days post op. Get excited, you'll get it done. ????

[mcclayne 36]

One thing that did help me was needing CPAP

How is your blood pressure?

BMI ?

[Loss78 50]

Hi mcclayne I am 5'5 and I believe my bmi is like 36. It is SO inspiring to hear that you were approved!!! Congrats on being 19 days post op! I cant wait to see how it works for me. Getting excited to hear if I get approval!

[donnag53 72]

I also have Atena. I am on meds for high blood. According to my surgoen Atena wil not approve for this only. I have sleep apnea and use a cpap. This should be my in but i have not been officially approved yet. Good luck to you.

[mcclayne 36]

Aetna approved me because of CPAP, no high blood pressure, but my BMI was 41

CPAP and High blood pressure I hope should do it.

Lots of joint pain? Do either of you have degenerative joints? Most obese people do.

[Loss78 50]

It's very upsetting to me about my sleep study as well!! When I went for the study I was so very uncomfortable and didn't sleep a wink until right before I had to leave. I got under 2 hours of sleep in the early morning hours. When I went for my follow up & explained to the doc that I didn't sleep, he told me I did sleep and that the only time I had sleep apnea was in the early morning hours. I stopped breathing 8 times an hour. He said I only stopped 1 time an hour preceding that... I tried explaining to him that, that was when I didn't sleep but he insisted that I did. He explained that I need to lose weight to get rid of the issue I have but don't need the cpap machine. I wonder if it's possible to get a 2 nd opinion. I was so very nervous because my study was done at the docs office, not a hospital or anything and there was only a man (stranger) outside my unlocked bedroom. I have had a bad feeling about this ever since but now reading your posts it is making me re-think taking his word for it. I don't have high bp in fact I used to have very low bp but now it seems to be perfect all of the time. I only have the pre diabetes, high cholesterol (but not on meds for) and asthma which I do take meds for.

[mcclayne 36]

I did home sleep study.

Look up pre-morbidity diseases. How close pre-diabetes? Seems like your bmi too low and your not quite high enough to make it maybe

[donnag53 72]

I did a home study first and my heart stopped 97 times in one home. This lead to an over night study at the hospital. I think i would seek a second opinion. Like i said above i'm still waiting for approval. My bmi is like 37.

[donnag53 72]

Sorry about the spelling errors. I met one hour

[Loss78 50]

I cant thank the two of you enough for the advice! I am looking up pre - morbidity diseases right now. It helps having people to talk to while going through the grueling process of getting approved. I know own my health is not good due to my weight. I have a hard time breathing and the whole pre diabetes and high cholesterol takes its toll on me. I see that Migraines is on that list if pre morbidity diseases as well and I suffer from those and am on meds for them. So fingers crossed!! I just want to get back to being healthy again!! It's been a long 15 years of dealing with weight issues and I am just so ready to get back on track. Thank you ladies!! And donnag53 I will be looking forward to an update that you receive approval!! ????

[donnag53 72]

I will let you know when I hear from Aetna. Keep in touch and let me know how you are doing.

[Loss78 50]

Well I seen my pcp today and she looked through all of the reports that I needed for approval and she doesn't seem to think there is going to be a problem getting approved! She submitted all paperwork today and said I should hear something in the next few days! So needless to say I'm on pins and needles!! I will most certainly keep ya updated!!

[Loss78 50]

Got APPROVED for surgery today!!! On cloud nine!!! I have to wait an entire month before I get to meet with the surgeon but that is nothing after waiting so long to just know there is a change in sight!!!

[mcclayne 36]

So happy for you!