Ok Guys , I need your advice ... Aetna

[Jmone 0]

Hi everyone , Before making the decision for Lap-Band surgery my BMI was 42.6. I then went on the weight loss pill phentermine for a year and lost approx 20 pounds with 4 days of hour long cardio/kickboxingand have been on a pleteau so my DR and I decided maybe lap band is the way to go . I have been on the Aetna 3 month plan and I started on Nov'08 , When I met with the surgeon he gave me a surgery date of 3/30/09. My BMI is 39.6 so as required with Aetna I need a co-morbidity ... Needless to say I do not have high blood pressure nor diabetes etc.. I do have PCOS but I am aware that does not qualify me for much . I just received my results from the sleep study and it shows I have a mild case of sleep apnea. Now my question is would a mild case of sleep apnea be enough to get an approal from Aetna ? Does anyone know ??

[adagray 1]

I have Aetna too. For the sleep Apnea to 'count' as a comorbidity, it must be 'clinically obstructive sleep apnea' which is defined in one of their 'clinical policy bulletins' (CBP 004 - Obstructive Sleep Apnea). If you bring up the clinical policy bulletin for obesity surgery (0157) there is a link to the cpb they have on obstructive sleep apnea. I think you need to be using a CPAP (?) machine... that mask you wear at night to help you breathe. All that said, I would still try to get your surgery approved. They might deny you, but then you can appeal.

[Jmone 0]

Right , and DR's comments on the study report is for the sleep apnea to be treated with a CPAP machine . I have a call into the Dr's office so they can explain further , thanks for your response

[carla08 0]

I do not have aetna but have they checked an A1C to see if perhaps you would be considered a type II diabetic also a comorbidity, do you have bakc or knee pain due to being overweight also can get you approved your Bmi is very close can they reweigh you and submit the new weight generally best to weigh in the afternoon for higher weight good luck

[DanaM 0]

I know you dont want to but eat alot before you go to the doctor and gain a few pounds. I had to gain to have it because I was right on the line. My BMI was 36 but I have high blood pressure and diabetic and sleep on a CPAP machine. Good luck!