New Here - Consult soon, hoping for good news

[bariatric_bridgette 1]

Hi everyone. I have been considering this surgery for a number of years, and the time has never been right. When I started to seriously consider it, it was prior to having kids. I was already facing some fertility issues (thanks to my weight and PCOS), and knew that I didn't want to delay starting a family further in order to have the surgery. I was heavier then, and probably would have qualified easily, as I'm assuming my BMI was close to if not over 40. Fast forward 7 years, and I have 2 kids and I'm ready to get my life back.

My BMI is 35, but I do not have any comorbidities. I made an appointment at a Bariatric clinic that was recommended by a few friends who went through it. They know my weight/height and I did advise I don't have high blood pressure, diabetes, etc.. My thought and hope is that they scheduled the appointment because they still feel I'm a candidate. I'm not sure how that works, though. Per my insurance (Aetna), I have to be at a BMI of 35 with another weight related issue in order to be covered.

Does anyone have experience with centers like this and Aetna? Are they willing to work with your insurance in order to get covered? Or is it pretty much a hard and fast rule, and the doctors can't do anything to override it? I cannot pay for this out of pocket, so I'm praying that this all works out. My appointment is July 16.

Any advice or experience?

[JennAsVSG 1]

Hi everyone. I have been considering this surgery for a number of years, and the time has never been right. When I started to seriously consider it, it was prior to having kids. I was already facing some fertility issues (thanks to my weight and PCOS), and knew that I didn't want to delay starting a family further in order to have the surgery. I was heavier then, and probably would have qualified easily, as I'm assuming my BMI was close to if not over 40. Fast forward 7 years, and I have 2 kids and I'm ready to get my life back.

My BMI is 35, but I do not have any comorbidities. I made an appointment at a Bariatric clinic that was recommended by a few friends who went through it. They know my weight/height and I did advise I don't have high blood pressure, diabetes, etc.. My thought and hope is that they scheduled the appointment because they still feel I'm a candidate. I'm not sure how that works, though. Per my insurance (Aetna), I have to be at a BMI of 35 with another weight related issue in order to be covered.

Does anyone have experience with centers like this and Aetna? Are they willing to work with your insurance in order to get covered? Or is it pretty much a hard and fast rule, and the doctors can't do anything to override it? I cannot pay for this out of pocket, so I'm praying that this all works out. My appointment is July 16.

Any advice or experience?

Hey - I don't have any experience or advice - I'm kinda in the same boat - I have jumped through all the hoops - paid all the co-pays - had the required testing done (that I paid for out of pocket) - have submitted to insurance and was denied - awaiting the verdict of my peer to peer - my BMI is 36.3 and my comorbidities are GERD and Hyperlipidemia - hoping for good news.

Not sure if your July 16 is an information/consultation meeting - maybe they will be able to give you more info or 'find' a comorbidity that you didn't even know you had

Sent from my iPhone using the BariatricPal App

[bariatric_bridgette 1]

Hi everyone. I have been considering this surgery for a number of years, and the time has never been right. When I started to seriously consider it, it was prior to having kids. I was already facing some fertility issues (thanks to my weight and PCOS), and knew that I didn't want to delay starting a family further in order to have the surgery. I was heavier then, and probably would have qualified easily, as I'm assuming my BMI was close to if not over 40. Fast forward 7 years, and I have 2 kids and I'm ready to get my life back.

My BMI is 35, but I do not have any comorbidities. I made an appointment at a Bariatric clinic that was recommended by a few friends who went through it. They know my weight/height and I did advise I don't have high blood pressure, diabetes, etc.. My thought and hope is that they scheduled the appointment because they still feel I'm a candidate. I'm not sure how that works, though. Per my insurance (Aetna), I have to be at a BMI of 35 with another weight related issue in order to be covered.

Does anyone have experience with centers like this and Aetna? Are they willing to work with your insurance in order to get covered? Or is it pretty much a hard and fast rule, and the doctors can't do anything to override it? I cannot pay for this out of pocket, so I'm praying that this all works out. My appointment is July 16.

Any advice or experience?

Hey - I don't have any experience or advice - I'm kinda in the same boat - I have jumped through all the hoops - paid all the co-pays - had the required testing done (that I paid for out of pocket) - have submitted to insurance and was denied - awaiting the verdict of my peer to peer - my BMI is 36.3 and my comorbidities are GERD and Hyperlipidemia - hoping for good news.

Not sure if your July 16 is an information/consultation meeting - maybe they will be able to give you more info or 'find' a comorbidity that you didn't even know you had

Sent from my iPhone using the BariatricPal App

My 7/16 appointment is an informational meeting and then a 1:1 with the surgeon. It's not a hospital, but a Bariatric Clinic. I am taking comfort in that, because this is the stuff they specialize in. I don't have to get any referrals or see my primary care physician, so I'm hoping that if this doctor finds something for me (and I'm hoping that's the kind of thing they'd do with someone so close but yet so far away) and deems in medically necessary, that my insurance will comply.

Good luck on this last hoop of yours. I hope it all works out for you.

[Amurillo04 109]

Normally under 40 with no comorbities will be denied but if you don't try you will never know and the doctors and coordinators may be able to help you through the hoops. Good luck

Sent from my iPhone using the BariatricPal App

[bariatric_bridgette 1]

Normally under 40 with no comorbities will be denied but if you don't try you will never know and the doctors and coordinators may be able to help you through the hoops. Good luck

Sent from my iPhone using the BariatricPal App

Yes - and I am preparing myself for the worst, but hoping for the best. I do hope that because it's a Bariatric Center vs. a normal hospital, they are willing to help me. I realize that insurance qualifications are what they are, but keeping my fingers crossed!

[Amurillo04 109]

Normally under 40 with no comorbities will be denied but if you don't try you will never know and the doctors and coordinators may be able to help you through the hoops. Good luck

Sent from my iPhone using the BariatricPal App

Yes - and I am preparing myself for the worst, but hoping for the best. I do hope that because it's a Bariatric Center vs. a normal hospital, they are willing to help me. I realize that insurance qualifications are what they are, but keeping my fingers crossed!

It's always best to have hope and a good coordinator on your side. I agree that a bariatric center is much better in terms of insurance approval because many times if your in a good place the coordinators are specially trained to obtain approvals because they want your money:). Also if your insurance has centers of excellence definitely go to them. It makes a difference!

Sent from my iPhone using the BariatricPal App