Question about co-morbidities

[AliciaA122 24]

I have an appointment with a surgeon in a week and a half. I have Aetna and have verified that I have the WLS rider. However, I have a question about the co-morbidity requirement. For the past 5+ years my bloodwork has indicated high cholesterol and elevated sugar levels, but I am not on any medication for those conditions. In fact on my last fasting bloodwork my glucose level was 129, which in doing some research appears to be in the diabetic range. My PCP has never recommended anything but diet changes, perhaps because of my age (30.) I also routinely have high blood pressure when I go to the doctor's office.

Do you have to have a history of having your co-morbidities treated? Know what I mean? I worry that even though my medical history shows years of weight-related problems none of them have been treated with medication and that could be a problem.

A little about me: 30 yo female, 5'6", 310 lbs.

[MacMadame 81]

Aetna only counts high blood pressure if it's not controlled by medicine. I don't know about cholesterol but I vaguely remember it's the same.

Their bariatric policy is here:

Obesity Surgery

It's got all the details.

[spud.mama 7]

Presence of severe obesity that has persisted for at least the last 2 years, defined as any of the following:

1. Body mass index (BMI)* exceeding 40; or
   
2. BMI* greater than 35 in conjunction with any of the following severe co-morbidities:
   

On Aetna's requirements it says BMI exceeding 40 OR co-morbidities. You have a BMI of 50 and atleast 2 years proof over 40 BMI then you do NOT need a co-morbidity.

Co-morbs help but not necessary. You do not need to worry, you qualify.

Hope this helps! Good Luck!

[AliciaA122 24]

Thank you both so much! I couldn't find the bariatric info on Aetna's site anywhere. :tongue_smilie: I didn't look hard enough I guess. Thanks again!

[GreyhoundGirl 0]

When I was worried about Aetna when I was starting this process (I too couldn't find a THING on their website...)

I called Aetna... spoke with an awesome rep and got all my questions answered plus they sent me out a packet of info. I was SHOCKED that they were so nice. You always hear horror stories about insurance companies... I was impressed.

Good luck!

[adagray 1]

Two things I recommend...

1) Meet w/your PCP and explain that you want WLS and explain what is needed for comorbidities. Ask who she/he recommends for bariatric surgery. And, ask for a letter of medical necessity. If your PCP is supportive, then they can be a great help to make your case for you and document things in your favor to get the surgery. If your PCP is not supportive, its better to find out right away so you can move on to one that is.

2) Get a sleep study done. I was sure I didn't have sleep apnea, but the more I learned about it, the more I realized I might have it. So, I went for the sleep study and sure enough, I have it. So, now I have two comorbidities (w/my high bp). Lucky me! LOL

Aetna doesn't count high cholesterol as a comorbidity. Its something your doctor should still mention in the letter of medical necessity (as extra reason why you need the surgery), but that in itself is not enough to get approved.

I wish you all the best w/this. Its quite a process. I'm not done w/insurance yet myself.