daco525 0 Posted November 29, 2008 I am really working hard to gather info. I currently have Horizon BCBS of NJ. I have a BMI of 36 with the following co-morbidities: diabetes typeII, hypertension, high cholesterol. My BMI has fluctuated from 34-36 in the past two years. So far I have a note from my primary. He also list the last 9 months weigh ins. I went for the psychological eval last week. I have an appt for the nutritionalist eval next week. I wonder if I should send all my daily food logs from Weight Watchers along with my 6 month weigh in notes. I am so afraid of being denied. My paperwork will show that I was successful on WW, I lost close to 30 lbs. but unfortunately I gained it all back in 3 months. The sad story of my life. I need to get off this roller coaster and I am hoping the lap band will help me. If anyone has any suggestions of what else I should send to help my case, please share. Share this post Link to post Share on other sites
tashanicole1271 0 Posted November 30, 2008 I think you should send anything that will show your need for the surgery. I have Aetna insurance and just got my approval letter in the mail on Friday. My insurance required a BMI of 40 if there were no comorbidities. I was right at 40 with none, or so I thought. I ended up with slightly elavated blood pressure, which my PCP considered weight related. I think you are on the right track, just send everything you can to the insurance company. Share this post Link to post Share on other sites
Lady Lap Band 71 Posted December 15, 2008 I think you should send anything that will show your need for the surgery. I have Aetna insurance and just got my approval letter in the mail on Friday. My insurance required a BMI of 40 if there were no comorbidities. I was right at 40 with none, or so I thought. I ended up with slightly elavated blood pressure, which my PCP considered weight related. I think you are on the right track, just send everything you can to the insurance company. Hi there, Seeing you have Aetna and were approved and I also have Aetna I was hoping I could ask you a few questions.... I have a BMI of 41.6 so I am all set when it comes to that.... I am doing the 3 month surgical preparatory regimen that Aetna required. Were there any special documents that you submitted. Also, how long before you got an answer from them? Thank you! Share this post Link to post Share on other sites
Rhonda1966 0 Posted December 15, 2008 I have Aetna pos ,and I live in upstate New York .. I have one last appointment to go to today. The heart specialist ,I will be asking him to write a letter on my behalf ,since he feels this would be a great new beginning for me . I just found out I have sleep apeana and have to go back for a c-pap mask fitting another over night stay at the hositpal ,also knee pain that I have been on meds for (pain killers) for the last 3 years , high blood pressure, depression,BMI of 41.2 I'm 5'2" and weigh 235.2 last weigh in .I also have a hetial hernia that I didn't know,they said they can repair that during lap-band surgery . Last but not least ACID REFLUX that is the worst to me .I also did the 3 months requirment set by Atena ,and after the sleep test on Dec. 29th .Everything will be sent in .My doctor who is writing a letter also feels this will help me in the long run . I gave my surgeon all my Weight Watchers cards from 5 yrs ,and gym membership (Curves)that way the insurance company can't say I didn't try . I 'm hoping for a Janurary 2009 date , anything you can get from doctors will help.Every night I write down a little something to enclose in my personal letter when everything does get sent in . I am very excited and have a good feeling about the insurance company saying yes to me .Please let me know how you are doing ,I really would like to know,and maybe I can help you along the way since I'm just a few steps ahead of you .Who knows we might get the same month or you before me . We can help each other through this . Share this post Link to post Share on other sites
Lady Lap Band 71 Posted December 15, 2008 I have Aetna pos ,and I live in upstate New York .. I have one last appointment to go to today. The heart specialist ,I will be asking him to write a letter on my behalf ,since he feels this would be a great new beginning for me . I just found out I have sleep apeana and have to go back for a c-pap mask fitting another over night stay at the hositpal ,also knee pain that I have been on meds for (pain killers) for the last 3 years , high blood pressure, depression,BMI of 41.2 I'm 5'2" and weigh 235.2 last weigh in .I also have a hetial hernia that I didn't know,they said they can repair that during lap-band surgery . Last but not least ACID REFLUX that is the worst to me .I also did the 3 months requirment set by Atena ,and after the sleep test on Dec. 29th .Everything will be sent in .My doctor who is writing a letter also feels this will help me in the long run . I gave my surgeon all my Weight Watchers cards from 5 yrs ,and gym membership (Curves)that way the insurance company can't say I didn't try . I 'm hoping for a Janurary 2009 date , anything you can get from doctors will help.Every night I write down a little something to enclose in my personal letter when everything does get sent in . I am very excited and have a good feeling about the insurance company saying yes to me .Please let me know how you are doing ,I really would like to know,and maybe I can help you along the way since I'm just a few steps ahead of you .Who knows we might get the same month or you before me . We can help each other through this . I called Aetna, I also have POS and they said that they do indeed cover lap band up to 90%. My husband told me that in January we are switching to a better Aetna plan, I don't remember what it is but I would assume that would only work out better for me. Other than that I have only read what Aetna says online about their obesity surgery. My doctors have shown no concerns about me getting approved by them. I have a BMI of 41.6 and currently the only co-morbitity I have, if they even consider it one is heartburn. It's nice to know of another person who also did the 3 months. I didn't understand that at first until my Dr. explained it, I thought I was going to have to do the 6 months with my PCP. Do you think I should get documentation from any/all of the gyms I have ever been members of? I have done weight watchers 2 times.....I dont have the book from the first time but I can get documentation of the 2nd time, do you think i should get that as well for Aetna? I have to go to the Pulmonologist on 1/30 for a sleep consult I am trying to get an earlier appt is possbile. In about 4 weeks I am also getting a EKG and meeting with the nutrionist again. My hospital had a mandatory 4 class pre surgical life skills group I have to do...my are every monday in february. I also have to loose 10-15lbs before surgery. Onace I have lost half that weight....been to half the classes, and have of my pre op testing has been done I can schedule a surgery date. I am excited! Anything imparticular you suggest I send tot he Aetna? Share this post Link to post Share on other sites
Rhonda1966 0 Posted December 15, 2008 I called Aetna, I also have POS and they said that they do indeed cover lap band up to 90%. My husband told me that in January we are switching to a better Aetna plan, I don't remember what it is but I would assume that would only work out better for me. Other than that I have only read what Aetna says online about their obesity surgery. My doctors have shown no concerns about me getting approved by them. I have a BMI of 41.6 and currently the only co-morbitity I have, if they even consider it one is heartburn. It's nice to know of another person who also did the 3 months. I didn't understand that at first until my Dr. explained it, I thought I was going to have to do the 6 months with my PCP. Do you think I should get documentation from any/all of the gyms I have ever been members of? I have done weight watchers 2 times.....I dont have the book from the first time but I can get documentation of the 2nd time, do you think i should get that as well for Aetna? I have to go to the Pulmonologist on 1/30 for a sleep consult I am trying to get an earlier appt is possbile. In about 4 weeks I am also getting a EKG and meeting with the nutrionist again. My hospital had a mandatory 4 class pre surgical life skills group I have to do...my are every monday in february. I also have to loose 10-15lbs before surgery. Onace I have lost half that weight....been to half the classes, and have of my pre op testing has been done I can schedule a surgery date. I am excited! Anything imparticular you suggest I send tot he Aetna? Breanne I would collect everything and anything you have in regards to your attempts at dieting . The more proof the better off you will be in the long run. I went to my heart specialist this afternoon ,and he gave me clearance along with a letter of how he feels this would be an excellent tool in me getting healthy . I also went to my OBGYN ,and she also wrote a wonderful letter . I figure I'll cover all bases . I want to suggested that you collect 5 years of weights .Aetna told me two years ,but again better safe than sorry. I also keep copies of all test and blood work ,as soon as they come in to my doctors I head to him and have the office personal make me copies. That way if something is missing I can be right on it . I have waited too long for this surgery and I 'm you have too .I can't wait till the day I can buy that something so special that I thought I would never get into . My husband is so supportive and excited for me ,he is with me every step of the way cheering me on . Sounds like you have great support in your husband also . Please let me know if you have any other questions about going through this now I don''t feel so alone ,in my mission to get healthy . . God Bless and talk with you soon Share this post Link to post Share on other sites