Aetna and "long-standing" obesity -- Hmmm...

[mishakal 0]

My highest weight was 244 when I was 19. I lost down to my lowest weight of 145 by the time I was 21, and it's been coming back slowly but surely. I've had a BMI over 35 for the last two years, but as I don't know if I have any health problems (haven't had a physical in many many years) I can't guarantee that will be enough.

I am almost positive I can acquire my doctor's records from my heaviest time. I also should have records with a rheumatologist I saw that will have my weight for parts of the time while I was losing -- and I can get my gynecologist's records and those have my weight from the time I was 18 on until now -- except for a few years gap when I moved out of state.

Does anyone have any experience here with being on the borderline portion for Aetna's history? Are they looking for 24 solid months of being over 40 BMI? I think that would disqualify a lot of yo-yo dieters right there ...

[adagray 1]

Well, first thing, definitely find out if you have any of the comorbidities because if you do, then you have met the qualifications and should be approved. Aetna requires a 3 or 6 month diet (details are in their clinical policy bulletin Obesity Surgery )

If you don't have any comorbidies, then I think you will probably get denied the first go-around. I'm actually in a very similar situation in that I have comorbidies and BMI of 38 right now, but my BMI went below 35 in 2006 and 2007 because I was on WW. But, I can show BMIs of 35+ for 2002-2005. I have not submitted to insurance yet (probably will in about two weeks - after my sleep study). But, I fully expect that they will deny me. Basically, from what I've read on here, the first go around w/insurance tends to be very unforgiving. If the insurance company can find ANY reason to deny you, they will. But, then there is chance for an appeal through the insurance company (where someone looks more closely as to why they are denying you and MAYBE they will approve you). Worst case, it goes to outside review which is the point at which I think both you and I would win our cases because then the approval/denial is based on NIH standards instead of Aetna standards. And, NIH says nothing about the history of obesity having to be in the last two years. In fact, that we are able to show that we could take significant weight off on our own (but without success at keeping it off) makes us ideal candidates for this surgery.

Anyway, I will update here as I go along my journey w/this. And, I wish you all the best with this. I definitely think its worth pursuing. My mom got lapband just over one year ago and has lost 95 pounds. :->

[misslonglegs 0]

Hello, have faith in atena I was approved within 48 hrs,keep calling stay on them also I do not stress the 2 year weight because if you have a good insurance corniator they will go thru the hoops to get you approved,I have been only morbid obese for 1 year.

[msperson 0]

hi i have aetna and had to submit 5 years of medical history with your weight on it. i dont know how hold you are but it had to be 5 years past history. Aetna is one of the easiest to get approved for! Good luck!

[MacMadame 81]

FYI, they changed the 5 years to 2 years about a year ago.

[Pezo 0]

I also have Aetna......I have always kept in the back of my mind that I wanted to consider weight loss surgery,and knew that they definatle required documentation of wieght loss efforts over a 2 year period so in 2007 I saw a doc and did a program....well in Oct. I decided to go for it....only 2 find out that my weight was just written down in 2007 you really need to make sure it is listed on an actual Dr.s note and ask for a copy when you go for a visit....so my 3 consecutive months were no use to me but in the following months I kept seeing my Dr. and having him notate continued weight loss efforts and as of 3/2/09 I got an approval.....I have no co-morbid issues but a bmi of 45....And they did request a weigh in form 2006 with I thought I didn't have because I hardly go to a Dr. so I searched and found that I had seen my gyno....man I was never so happy that I had gone to a gyno.....I say go for it and see what they tell you then give them the documentation they need......oh and I also called every other day.......good luck

[msperson 0]

My weight lady made me get 5 years! medical hsitroy!

[Lady Lap Band 71]

I have Aetna! My BMI fluctuates between 40-41 I weigh 248. I just called Aetna and they said the letter of decision (approval or denial) has been mailed and is on its way to my doctor! They didn't tell me though! So now I have to wait till Monday to see! Hopefully the letter will have reached my doctor by then!

[Pezo 0]

Wow that really sucks......On the day they determined my approval I actually called my doc and the receptionist was like oh man I wanted to surprise you.....I just wish they had to wait like we wait sometimes I know that its gonna be a long week end for you good luck....hey at least their not saying that they need more info....keep in touch

[Mona40 0]

They could given you an answer over the phone. Don't worry Monday will be here soon. Aetna will receive my paper work on Monday and I'm scared its going to be a long waiting period. Hopefully I will get an answer within 2 week. How long you has it been for you?

[Lady Lap Band 71]

They could given you an answer over the phone. Don't worry Monday will be here soon. Aetna will receive my paper work on Monday and I'm scared its going to be a long waiting period. Hopefully I will get an answer within 2 week. How long you has it been for you?

Um, I'm not really sure what the actual date was that my surgeon sent the paperwork to Aetna, but I received a letter from Aetna dated 2/27 requesting additional documentation. My surgeon sent that paper work after receiving the request and now the answer is on it's way! I am hoping it's an approval! Let me know how it goes for you!

[2Legit2Quit 0]

Ahhh!!! What happened Gonna Loose it?!?! lol I'm dying to know! My insurance info was sent last Tuesday I believe..and I called today but aetna said they don't have the info yet :laugh:

[Lady Lap Band 71]

Ahhh!!! What happened Gonna Loose it?!?! lol I'm dying to know! My insurance info was sent last Tuesday I believe..and I called today but aetna said they don't have the info yet :laugh:

Hey! I have no heard yet! We had a ig snow storn today so the mail didn't make it there! I'll call again tomorrow and hopefully they will have it! I will let you know!

[Pezo 0]

O.K. hold up wait a minute...who pays the premiums?,,,,,Do you notaste names when u call these representatives..... I would ask for a supervisor because obviously there is a communications gap...the fact that I knew the same day that my doc did says something...tell them you want to know the status of your approval and if they cannnot tell you what they haave obviously determined is some BULL.....My husbands says his wife was given the runaround for awhile and come to find out they had lost her documentation.....he coautioned my husband that it was a hard thing to get info....anf=d my reply was he doesn't know me does he......I am a pittbull when it comes to making them earn their premiums.....I would call tomorrow and kick butt and TAKE NAMES.....good luck boo.........:laugh:

[misslonglegs 0]

Something is not right,i have atena in they told me over the phone once i got approved.