Surgeon's Office Won't Even Give Aetna a Chance!

[Ms. Nunya 126]

I'm am so bummed right now. I started this process a few weeks ago. My BMI is around 36. I was sent for a sleep study and I don't have sleep apnea. The surgeon's office emailed stating that my insurance would not cover me since I have do not have a BMI of 40. What do they expect me to do.... Gain more weight? I don't have extra funds just laying around. I am beyond upset..... Like wayyyyyyyy beyond. I'm getting a headache.

[jeanniereenie 177]

some offices offer payment plans

good luck!

[peaceout 273]

Do you have any of the other common comorbidities? Diabetes, HTN, hypercholesterolemia, PCOS, etc.?

It seems strange that they made everything ride on whether or not you had sleep apnea. I have no experience with Aetna, but many insurance companies will cover the surgery with a BMI of 35-39 if you have another comorbidity. That may not be true for your policy, but if your surgeon's office thought that having apnea would do the trick, there are probably other comorbidities that would count, too.

[Ms. Nunya 126]

Do you have any of the other common comorbidities? Diabetes, HTN, hypercholesterolemia, PCOS, etc.?

It seems strange that they made everything ride on whether or not you had sleep apnea. I have no experience with Aetna, but many insurance companies will cover the surgery with a BMI of 35-39 if you have another comorbidity. That may not be true for your policy, but if your surgeon's office thought that having apnea would do the trick, there are probably other comorbidities that would count, too.

i guess

I think I'm just heathy in spite of my weight. I knew for sure that I had sleep apnea because I snore now but never did when thin. I've only been heavy for about 4 years and it's now beginning to take its toll on my joints and digestion.

[LaLaLucy 22]

Aetna requires that you must have one of the following if your bmi is under 40. sleep apnea, hypertension, diabetes, or heart disease. In order for a diagnosis of sleep apnea, your breathing must stop for a certain number of seconds and they also track your blood gasses and pulse along with other things. Did you get a copy of your report? Just snoring doesn't mean obstructive sleep apnea which is what they are looking for. Good luck!

[Bobbe Schu 53]

I'm am so bummed right now. I started this process a few weeks ago. My BMI is around 36. I was sent for a sleep study and I don't have sleep apnea. The surgeon's office emailed stating that my insurance would not cover me since I have do not have a BMI of 40. What do they expect me to do.... Gain more weight? I don't have extra funds just laying around. I am beyond upset..... Like wayyyyyyyy beyond. I'm getting a headache.

Contact Lindstrom Obesity Advocacy. You can google them for contact information. Very reasonable rates for the advice and work they do. You need an advocate and they experience!!

[khaled 23]

I had the same situation a year and a half ago. My BMI was 36, my doctor told me you are healthy and Aetna won't cover the surgery.

I stopped going to my doctor, but this year I have a BMI of 40, so I went back to him and now I am in the process of the approval .

I guess you can find a doctor with payment plan or you should do it in Mexico .

If you are gaining weight crazy like I did, maybe you should weight till you have a BMI of 40, but I DO NOT recommend you to purposely gain weight just to get a BMI of 40.

[Ms. Nunya 126]

I had the same situation a year and a half ago. My BMI was 36, my doctor told me you are healthy and Aetna won't cover the surgery.

I stopped going to my doctor, but this year I have a BMI of 40, so I went back to him and now I am in the process of the approval .

I guess you can find a doctor with payment plan or you should do it in Mexico .

If you are gaining weight crazy like I did, maybe you should weight till you have a BMI of 40, but I DO NOT recommend you to purposely gain weight just to get a BMI of 40.

I'm definitely not trying to gain. I'm on a low carb diet now. I'm looking into self pay options and two other doctors.

I'm am so bummed right now. I started this process a few weeks ago. My BMI is around 36. I was sent for a sleep study and I don't have sleep apnea. The surgeon's office emailed stating that my insurance would not cover me since I have do not have a BMI of 40. What do they expect me to do.... Gain more weight? I don't have extra funds just laying around. I am beyond upset..... Like wayyyyyyyy beyond. I'm getting a headache.

Contact Lindstrom Obesity Advocacy. You can google them for contact information. Very reasonable rates for the advice and work they do. You need an advocate and they experience!!

I will look them up. Thanks!

Edited June 21, 2015 by mrsFAB

[majorsmama 91]

Aetna is very clear in their weight loss surgery bulletin about what they require. If I were you, I would be grateful the surgeon told you now not to bother, rather than have you pay a bunch of money and jump through hoops only to be denied.

[Bobbe Schu 53]

You contact Lindstrom Obesity Advocacy and consult with them before you give up!!! Trust me. They are able to find loopholes and interpret policies that we can't.

[Ms. Nunya 126]

You contact Lindstrom Obesity Advocacy and consult with them before you give up!!! Trust me. They are able to find loopholes and interpret policies that we can't.

Oh I'm not giving up. I will contact them. Thanks for the support!

[Bobbe Schu 53]

You contact Lindstrom Obesity Advocacy and consult with them before you give up!!! Trust me. They are able to find loopholes and interpret policies that we can't.

Oh I'm not giving up. I will contact them. Thanks for the support!

You won't be sorry. Good luck to you. Good luck to me. Good luck to us all.