What are my chances? Aetna PPO NAP

[fatkitkat 0]

Morning, everyone!

I'm 38 years old with a current BMI of 41. The lap band is covered by my insurance, Aetna PPO NAP. I can prove 2 years of obesity, inlcuding previous BMIs between 35.0 - 37.5.

Do I still have to prove comorbidities because of the lower BMIs even though now my BMI is over 40 (just recently by the way)? Any opinions/experience?

I have hypertenstion (153/98) but it's untreated. My PCP doesn't seem concerned about it but he is supportive of my pursuit of the band. Should I ask him to put me on meds? I've had a lot headaches in the last few months and wonder if the BP is the cause. If he puts me on meds and my hypertension resolves...then it doesn't count as a comorbidity, right?

Thanks for any help. Been waiting 2 weeks trying to get an appt with my chosen surgeon.

Kathy

[spud.mama 7]

Hello :w00t: Hypertension is a comorbidity--even if on meds. You should be fine qualifying. Don't worry.

Aetna has a lot of hoops to jump thru, have u seen the requirements? U can find it on aetna.com somewhere, or google aetna, obesity surgery. It's also on here somewhere on the insurence forum. Most people do the 6 month program, but I'm trying to do the 3 month multi-disapplainary (which it ending up to be 4 months for me cuz I missed some exercise classes and I started late--love that exercise!! :tt1:).

Talk to the insurence person at the surgeons office, she should be able to tell you exactly what to do. OH, also make sure the surgeon is in network.

Good luck!

[fatkitkat 0]

Thanks for the reply, I was getting worried! I finally just called my surgeon's office and I have an appt on April 20! I also called my PCP and made an appt for Monday to discuss my blood pressure.

What's worrying me is Aetna's requirement that hypertension is only a co-morbidity if it is being treated with meds and not responding.

On April 20 I'll see about getting schedule for a sleep study. I don't feel like I have apnea, tho. But here's hoping!

[ksill18 0]

I had a BMI of 40.1 and only comorbidity was mild sleep apnea and I qualified with Aetna. You should be fine!! GOOD LUCK!!

[fatkitkat 0]

Hi, KSILL18, thanks for the reply. I was wondering...was your 40.1 BMI for your whole 2 yr weight history or did you did below 40 at all?

[spud.mama 7]

What's worrying me is Aetna's requirement that hypertension is only a co-morbidity if it is being treated with meds and not responding.

Your BMI is above 40. You don't need comorbidities. It helps, but not required. Just re-read your post about the previous 2 years and BMI 35-37. If you have high blood pressure that's it for the comorb. Do you have depression? That can be one also.

Don't worry--be happy! :thumbup: I've heard that even if they do deny you just keep submitting, they just want to see that you really want it. Look thru the forums, go far back if you have to. Many people have talked about it. That was actually how I found this forum--looking for a convo about it.

Don't worry.

[Lady Lap Band 71]

Morning, everyone!

I'm 38 years old with a current BMI of 41. The lap band is covered by my insurance, Aetna PPO NAP. I can prove 2 years of obesity, inlcuding previous BMIs between 35.0 - 37.5.

Do I still have to prove comorbidities because of the lower BMIs even though now my BMI is over 40 (just recently by the way)? Any opinions/experience?

I have hypertenstion (153/98) but it's untreated. My PCP doesn't seem concerned about it but he is supportive of my pursuit of the band. Should I ask him to put me on meds? I've had a lot headaches in the last few months and wonder if the BP is the cause. If he puts me on meds and my hypertension resolves...then it doesn't count as a comorbidity, right?

Thanks for any help. Been waiting 2 weeks trying to get an appt with my chosen surgeon.

Kathy

Hi There!

Hopefully this will make you feel better! I have a BMI of 40 and at the time of my insurance approval I had no comorbitities. My paperwork was submitted to Aetna by my doctors office....there was a couple of things extra they wanted to know and so they sent a letter to my doctor requesting it and my doctors office sent it. Then I got a letter in the mail stating they approved me as of 3/9. They were really easy for me and I have the lowest BMI that qualifies for the lap band! I think you'll be okay!

[PSJ71 0]

Hi KitKat,

I am finishing up my 3-month supervised diet, but at my last visit with my doc, he told me that Aetna is really good about approvals. He told me in their experience it's been 99% approval rate. I will have to go in for a second sleep study. My BMI is 48.1, so I'm hoping I will be approved as well.

Good luck to you !!