Was Denied by Aetna POS II today !!

[Jmone 0]

I just received a call from the Dr's office to say that I was denied . She told me they denied me due to my BMI is 39.6 and no cor-morbidities .. Mild sleep apnea is not enough and they do not consider PCOS . She said she has to give it to the DR and see if he wants to appeal . Is that my choice or his ? Also my PCP had me on Phentermine for over a year now and since I had to be on the PREV PAC (H PYLORI) I stopped taking the Phentermine and I have gained 7 lbs in 2 months . If I am not on these pills I will just gain .. I am so upset , What should be my next step... Weight currently is 203 at 5ft . I am so upset I cant think straight ... Not sure what to do now

[adagray 1]

I am no expert on this, but from what I've read on here before, I think you could just gain enough to get your BMI to 40 and then appeal w/the new weight. You are so close to a 40 BMI anyway, its silly they denied you. I mean you could probably 'gain' enough weight just by drinking a big bottle of Water before getting on the scale or wearing some heavy jeans and a jacket. ;->

[RestlessMonkey 7]

I agree with adagray. If the cut off is a BMI of 40, then ask to be reweighed. I have even known of people who do thinks like carry rolls of quarters in their pockets, weigh with shoes on, and eat like little piggies prior to the weigh in. OH and Water weighs about 1/2 pound per 8 ounces...so drink Water just before!

Sounds shady but come on, .4 of a BMI as a reason for denial? That's outrageous!

Good Luck!

[Jmone 0]

Not sure if this is good news or not , but I know I have gained some weight I was not sure how much . In the begining of this I was at 200 lbs ... but I went to my PCP in January so I called to see what I weighed in at and he told me at 205.5 that gives me a BMI of 40.1 . Now that was last month , maybe I gained another pound or two so at my current weight I am over a BMI of 40. I tried calling the DR's office and see if they will appeal with my new weight ...Wish me luck .