Aetna "weight history" question

[SandraVA30 0]

Ok, here is my dilemma - I am in the process of completing the 3 month multi program that Aetna requires. Part of their requirement is having a BMI over 40 (or 35 with co-morbities which I don't have) for the previous 2 years. Ok, so this is where it gets kind of tricky for me. I originally was going to start this process at the end of last year but was afraid they wouldn't approve me due to my BMI in 2006. I am a yo-yo dieter and in 2006 ONLY I had a normal BMI. Every other year it has been over 40. (That whole thing irritates me, I think they should look at OVERALL history, not just 2 years) Anyway...so now it's 2009 and I will be submitting for pre-approval at the beginning of March probably. Do you think submitting my weight history for 2007 and 2008 will be ok or do you think they will ask for 2006? And do the specific dates in 2007 and 2008 matter or just anytime during the year. I am just not sure how picky they are. If they ask for 2006 I am pretty much screwed. And what exactly do they want with "weight history" in terms of documents? The insurance coordinator at my surgeon's office says they just need a date and weight on letterhead from the doctor, not my entire medical records. In your experience, is that enough? I guess if worse comes to worse I will have to wait longer to submit for approval, but since it's 2009, I am thinking that technically they won't ask for 2006. Any thoughts/suggestions?

[ksill18 0]

no no no....someone has given you the wrong info. They look at your BMI now. They want your weight history to make sure that you didnt gain weight recently. I have Aetna and went through the same process (my surgery was December 3rd 2008). You just have to supply weight history for past 3 years and they only look at your BMI now. Also you may want to ask your doctor if a sleep study will help you. I went for one and had sleep apnea(didnt know I did) and that was my co-morbidity.

[SandraVA30 0]

Thank you for the response! So, since my BMI is over 40 now hopefully it will be ok. My concern is that in 2006 my BMI was no where near 40 because I had lost weight that year. But if they look at any other year, it is over 40. Does that make sense? Did you send over entire medical records or just a weight history signed by the doc or something? I am just going to be so annoyed if I go through this and pay all these fees for the program and then get denied by insurance.

By the way - how did your surgery go? :cursing:

[adagray 1]

Sounds like you are in a similar situation as myself. In my case, I do have comordities so my BMI just needs to be 35+, but here is my history...

Year Weight Height BMI

2002 210 65 35

2003 208/230 65 35/38

2004 213 65 35

2005 207/223 65 34/37

2006 195 65 32

2007 178 65 30

2008 210 65 35

2009 226 65 38

The reason I have two weights for 2003 and 2005 is because I was pregnant those years so those are my begin and end weights for my pregnancies.

My PCP said that she would be surprised if I was denied. The insurance people at my surgeon's office expect that I will probably be denied, but that it would be worth appealing because I have proof to show I was dieting (through WW) the ENTIRE time that my BMI dropped below 35. I was actually on WW for 2.5 years and have all my weigh-in books.

ANYWAY, I don't really have an answer for you because I am just beginning this process myself, but I would just suggest that you can as many past weights as possible that show your BMI as higher previous to those two years. Its ridiculous that we should be penalized for TRYING to lose weight and gaining it back. And, on the flip side, if you can't show that you tried to lose weight before, they won't approve you either. Kind of damned if you do and damned if you don't. In any case, I'm just gonna submit and expect to be denied, then make as strong as an appeal as possible.

I've also been advised by my PCP and on here that the more comorbidities, the better your chances. So, I'm probably going to go ahead and have a sleep study. I honestly didn't think I had sleep apnea (or even snored loudly), but when I was talking to my DH about it last night, he said that I do snore really loud around 2am and he pushes me over to get me to stop. Kinda funny that I didn't even know that. I have also abruptly woke up a few times gasping and coughing.

Edited January 12, 2009 by adagray

[Ronda1966 0]

Ok, here is my dilemma - I am in the process of completing the 3 month multi program that Aetna requires. Part of their requirement is having a BMI over 40 (or 35 with co-morbities which I don't have) for the previous 2 years. Ok, so this is where it gets kind of tricky for me. I originally was going to start this process at the end of last year but was afraid they wouldn't approve me due to my BMI in 2006. I am a yo-yo dieter and in 2006 ONLY I had a normal BMI. Every other year it has been over 40. (That whole thing irritates me, I think they should look at OVERALL history, not just 2 years) Anyway...so now it's 2009 and I will be submitting for pre-approval at the beginning of March probably. Do you think submitting my weight history for 2007 and 2008 will be ok or do you think they will ask for 2006? And do the specific dates in 2007 and 2008 matter or just anytime during the year. I am just not sure how picky they are. If they ask for 2006 I am pretty much screwed. And what exactly do they want with "weight history" in terms of documents? The insurance coordinator at my surgeon's office says they just need a date and weight on letterhead from the doctor, not my entire medical records. In your experience, is that enough? I guess if worse comes to worse I will have to wait longer to submit for approval, but since it's 2009, I am thinking that technically they won't ask for 2006. Any thoughts/suggestions?

I have Aenta POS as my insurance ,and I was approved as a matter of fact tomorrow I will be having the lap-band in place . I gathered all my weights for 5yrs. mostly Weight Watchers cards ,and gym membership (Curves) .I did all my testing and happy I did ,since I never knew I had sleep apena ,and now I am on the CPAP machine level 10.

I was always tired out and never rested for about 3 years ,I have had it only 3 days I sleep all night and awake with no headaches I feel GREAT! I was missing 1yr of weights 2007,that's where my Curves came in to play ,I gave that (copies) to my insurance for submission ,and that worked just fine. Everything was sent in on Dec. 22 ,2008 and approved Dec.24TH. My weights were all over the place since 2005 up then down that shows I was attempting to lose the weight,also that I was and am a serious about weightLloss ,this could benefit you . Keep your head up and keep records on names of the people you have spoken to with dates,give copies of all your weights and medical records to the person who is doing your paperwork .I wish you much success and know you will be just fine .Everything has away of working it self out ,again Best Wishes!!!

[tashanicole1271 0]

Ronda,

I was also banded today! I hope everything went well for you. God bless.....

[Ronda1966 0]

tashaniciloe1271,

Congrats to you on your banding . I am up and trying to move around getting some of this gas to ex-spell:blushing:. My left shoulder feels like some punched me ,and ran . I have some swelling in the belly ,I am keeping ice bags on me . So far the pain is reasonable ,I will keep taking my pain killers . What hurts the most is trying to cough:eek: . How are you doing ? I hope your pain is bearable .Now I guess we are on the band wagon ,and it's time to heal ,and then start to work with our tools .Best of Wishes to you and please keep everyone posted .:thumbup:

[tashanicole1271 0]

Sorry to hear about your shoulder pain, Ronda. I am experiencing some swelling in my belly and difficulty coughing, but other than that, I am doing ok. Keep me posted on your progress, as I am sure you will do fine.