Newbie/Aetna/40 BMI

[bh1287 0]

This is my first post here so I'm a total newbie! I wondered if anyone with Aetna can tell me their experience with getting Aetna to approve their surgery with just a 40 BMI, no co-morbidities, & not having a history of a persistent severe obesity? I currently have a BMI of 38 and haven't been to a consultation yet. I spoke with the nurse at the office I'm wanting surgery & she hinted that it might be worth it for me to gain 15lbs so that Aetna will cover the surgery & I don't have to self pay. I wouldn't have a medical history of being at a 40 BMI at all. Most of my history would have me at 35-38. Do you think that would work & be worth gaining the weight? Does the insurance just go through if you are at the 40 mark? I couldn't get many answers from Aetna when I called other than to reference their policy #0157 bulletin.

Any advice or thoughts would be greatly appreciated!!

[PaulaWodzisz 9]

I can tell you that with my insurance, Medical Mutual, you have to have at least one year history of over 40 BMI if you don't have any co-morbidity. I was in the same situation as you and kind of cheated a little to get mine done. I slouched down when they measured me and it took almost 2 inches off my height. This made me shorter, so my weight (even from my primary doctor) still looked like I was at or near 40 for the year. The hardest part was the 3 month diet my insurance requires because I could NOT lose any weight, but you have to show that you made changes in your diet. My RNY is tomorrow and I have lost over 15 pounds on the 2 week pre-op diet. Good luck to you.

[Madtownsunshine17 42]

I also looked at the bulletin. It really depends on if you have any comorbidities. During the 3 month supervised process, I made sure not to go under 40 at any of my weigh ins. I was approved on my 1st letter. Not sure if I was just lucky, or played the game appropriately. The other thing is that you can't have a gain overall from your first weigh in. Hope this helps.

[funkecoldmedina 49]

I have Aetna Choice POS II (open access). I too have no co-morbidities however my BMI was over 50 when I first started my supervised visits. I will tell you that I am required to submit 2 years worth of weight history. Both of which show myself over a 40 BMI. I know for me this is a requirement for approval but if there is anything I learned about this process is that everyone is different and insurance is beyond confusing. So when it comes to other peoples insurance experiences, take what we say with a grain of salt. Best of luck to you! I know getting started is the most difficult as their is so much to learn about your new life.

[Sajijoma 1,324]

I have Aetna as well and I don't think just gaining 15lbs will qualify you. They want a minimum of 2 yrs worth of medical records showing a recorded weight and BMI over 40. I'm pretty sure just gaining 15lbs won't help you unless you plan to hang on to it and go to the doctor for the next say 6 months or so before starting the process even. I'd talk to your PCP. They could do a thorough work up and maybe find you some comorbidities. I understand that even something like stress urinary incontinence can count as a comorbidity so, it's worth a try to do that instead of putting on more weight to struggle with.