Aetna and BMI at 40

[Dee_Rose 6]

Hi All

I have been researching for a while and I have my first appointment with a surgeon today to discuss getting sleeved.

I have Aetna insurance. My BMI is right at 40. (5’3, 224) From what I understand, I have to have 4 consecutive months with a dietitian under my belt. As long as I’m at BMI 40 they will cover the cost. I’m worried I will lose too much weight in the 4 months then I won’t be eligible. If I’m between 35-40 BMI I have to have a comorbidity and I don’t have one. For whatever reasons (insurance ugh) I cannot get a straight answer from Aetna. Maybe all my questions will be answered today just wondering if anyone has any insight on this topic.

[kakatlady612 1,053]

Usually they use the weight you have at your first surgical visit as the base line. Don't piddle too much before your visit, don't want them to refuse for lacking an ounce. Seriously you'll do just fine. See if your surgeon is someone you can get along with. Its not mandatory to necessarily fall in love with them, if they sound and act at ease with you,it does help. Remember you will be asleep under the care of this person and the anesthesia doctor, do you find him/her trustworthy? Surgeons tend to act a little pushy but wouldn't you prefer somebody confident to a scared little rabbit of a person? You can tell them what surgery you prefer but also listen to their advice. I went into my 1st office visit ready to ask for one variety but I did listen to my surgeon, the points he made were very valid, he didn't advise because it was easier for him but rather better for me. He did, over several visits, make me feel I had made proper plans for,my WLS and on my surgery morning I will go to sleep in a very relaxed state knowing I'm in the right place having the right surgery and the right person with the technical skill to carry it off. Hope yours will go just that well.

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[Down South Aussie 65]

36 minutes ago, kakatlady612 said:

Usually they use the weight you have at your first surgical visit as the base line.

Not always so, my group submits my weight that i am at when i do my last weigh in before the packet is submitted. So while i started at BMI of 43 i am not down to almost a 40 and i have 5 more weeks before my packet will be submitted.

[kakatlady612 1,053]

You know that makes sense also. BiddyNZ says this morning they are having a tropical cyclone. Aren't you glad you're in Oz instead of New Zealand?

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[Down South Aussie 65]

2 minutes ago, kakatlady612 said:

You know that makes sense also. BiddyNZ says this morning they are having a tropical cyclone. Aren't you glad you're in Oz instead of New Zealand?

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Yeah i saw that, I Actually live in SC now though.

[kakatlady612 1,053]

Girl you do get around don't you? And here I am stuck in a 60 mile radius in Ohio. Wahh seems like Ii never get to go anywhere. Welcome to,my pity party, catered by,me.

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[Dee_Rose 6]

Had my first appointment , went well. He suggested I stay at 40 until the day of surgery so there is no denying my coverage.

[BGMOM12 3]

Dee-Rose, I am in the same boat as you with the 40 BMI. I am just at 40. They are submitting me to Aetna today and I am freaking out. Hopefully it won't take that long to find out if I am approved. Do you know when they are submitting you to insurance?

[Dee_Rose 6]

Dee-Rose, I am in the same boat as you with the 40 BMI. I am just at 40. They are submitting me to Aetna today and I am freaking out. Hopefully it won't take that long to find out if I am approved. Do you know when they are submitting you to insurance?

Well I have to have the 4 consecutive months worth of meetings with the dietitian... then they submit after that last one and they said they hear back within 2 weeks. Did you have to stay at 40 BMI for the whole 4 months?? Would love to hear when you get approved.

[BGMOM12 3]

I have been at the 40 the whole time. Originally I thought I was 38 but for whatever reason the DR had the incorrect height in the system when he calced my BMI and i was actually at 40 (I should have done it myself). So because i thought i was under to begin with I never tried to loose any weight and I had to go for a sleep study(so annoying). Then my original nutritionist didn't really do what she was supposed to do so I had to switch last week (no weigh ins). So I am basically praying that it all works it self out. If I get approved with all these crazy circumstances, I would think you would have no problems.

I would think they would submit you at 40 BMI. The doctors are trying to help you and know the insurance companies play stupid games.

I'll let you know when I hear back.

[336Mike 549]

The insurance companies, by law, have to follow their established clinical policies. Everything from the Dr and nutritionists has to tick and tie to go smoothly. Experienced bariatric offices know the rules and typically follow what's needed for each insurer so that it goes smoothly. Hope things work out for you.

VSG 10/11/17 HW = 360 SW = 292 CW = 225.2 GW = 220 (6'5")

[Dee_Rose 6]

I have been at the 40 the whole time. Originally I thought I was 38 but for whatever reason the DR had the incorrect height in the system when he calced my BMI and i was actually at 40 (I should have done it myself). So because i thought i was under to begin with I never tried to loose any weight and I had to go for a sleep study(so annoying). Then my original nutritionist didn't really do what she was supposed to do so I had to switch last week (no weigh ins). So I am basically praying that it all works it self out. If I get approved with all these crazy circumstances, I would think you would have no problems.
I would think they would submit you at 40 BMI. The doctors are trying to help you and know the insurance companies play stupid games.
I'll let you know when I hear back.

Awesome yes keep me posted and I’ll do the same. Keeping my fingers crossed for you!

[Dee_Rose 6]

I have been at the 40 the whole time. Originally I thought I was 38 but for whatever reason the DR had the incorrect height in the system when he calced my BMI and i was actually at 40 (I should have done it myself). So because i thought i was under to begin with I never tried to loose any weight and I had to go for a sleep study(so annoying). Then my original nutritionist didn't really do what she was supposed to do so I had to switch last week (no weigh ins). So I am basically praying that it all works it self out. If I get approved with all these crazy circumstances, I would think you would have no problems.
I would think they would submit you at 40 BMI. The doctors are trying to help you and know the insurance companies play stupid games.
I'll let you know when I hear back.

Awesome yes keep me posted and I’ll do the same. Keeping my fingers crossed for you!

[Dee_Rose 6]

I have been at the 40 the whole time. Originally I thought I was 38 but for whatever reason the DR had the incorrect height in the system when he calced my BMI and i was actually at 40 (I should have done it myself). So because i thought i was under to begin with I never tried to loose any weight and I had to go for a sleep study(so annoying). Then my original nutritionist didn't really do what she was supposed to do so I had to switch last week (no weigh ins). So I am basically praying that it all works it self out. If I get approved with all these crazy circumstances, I would think you would have no problems.
I would think they would submit you at 40 BMI. The doctors are trying to help you and know the insurance companies play stupid games.
I'll let you know when I hear back.

Awesome yes keep me posted and I’ll do the same. Keeping my fingers crossed for you!

[Dee_Rose 6]

I have been at the 40 the whole time. Originally I thought I was 38 but for whatever reason the DR had the incorrect height in the system when he calced my BMI and i was actually at 40 (I should have done it myself). So because i thought i was under to begin with I never tried to loose any weight and I had to go for a sleep study(so annoying). Then my original nutritionist didn't really do what she was supposed to do so I had to switch last week (no weigh ins). So I am basically praying that it all works it self out. If I get approved with all these crazy circumstances, I would think you would have no problems.
I would think they would submit you at 40 BMI. The doctors are trying to help you and know the insurance companies play stupid games.
I'll let you know when I hear back.

Awesome yes keep me posted and I’ll do the same. Keeping my fingers crossed for you!