Preparing documents for insurance

[daco525 0]

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.

[tashanicole1271 0]

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.

[Lady Lap Band 71]

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!

[Rhonda1966 0]

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 .

[Lady Lap Band 71]

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?

[Rhonda1966 0]

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