AETNA--Does BMI have to be over 40 for 2 years?

[WDW Luver 0]

I am right on the edge right now. BMI is 39.2 or something like that. I am hoping I can reweigh next week and get it to 40! But now I am reading stuff on Aetna and am wondering if the 40 has to have existed for 2 years? I have been overweight for more than 2 years, but not over 40 BMI.

I don't have any of the other comorbidities that go with the lower BMI to qualify.

[ParrotheadCathy 0]

Not all (Aetna or any other ) policies are created equal! Employers customize the coverage offered to their employees to keep the premiums within their selected range of premiums. Once may require more than another. I say call your insurance company and ask all the questions you can think of. BMI? Do they need years of weight history? If so, how much? Do they require any doctor supervised weight loss attempt before approving surgery....ask it all. That way you know for sure.

[B_there 0]

Hi,

Try this link to Aetna's coverage policy. This will give you the general guidelines. Plan sponsor specific information will need to be applied after that, such as whether or not your company has an exclusion.

Hope that helps.

Obesity Surgery

[WDW Luver 0]

Hi,

Try this link to Aetna's coverage policy. This will give you the general guidelines. Plan sponsor specific information will need to be applied after that, such as whether or not your company has an exclusion.

Hope that helps.

Obesity Surgery

Thanks. I have read that and it is what is scaring me! It does sound like the BMI had to be over 40 for 2 years. But I am in Virginia and I also heard that they have a rule that may superscede the insurance regs. I read it but don't understand it. This is all so confusing. I guess I will just see if I can get more information from the insurance person at the WLC.

[Lady Lap Band 71]

Thanks. I have read that and it is what is scaring me! It does sound like the BMI had to be over 40 for 2 years. But I am in Virginia and I also heard that they have a rule that may superscede the insurance regs. I read it but don't understand it. This is all so confusing. I guess I will just see if I can get more information from the insurance person at the WLC.

My BMI is 41.6 and at that time when I was approved by aetna I had no co morbitities. Did you have a sleep study yet? I had a slep study and found I had apnea. If you had that, that's a co morbitity. Aetna states you must be BMI 35 w/ comorbitities and 40 with none. You have to have been overweight for more than 2 years. I don't think it says HOW MUCH overweight.

[740heatherm 0]

I am just staring my process and I too have Aetna. My lap band doc wants to send me for a sleep study. I talked to the lady at the Barix Clinic, and she advised that I either had to show a 2 year BMI of 40 or above OR BMI of 35 or higher with a co morbidity and that co morbidity had to have been treated during the last two years. So in other words, I couldn't get the sleep study done tomorrow and come back that I have sleep apnea and use that as my co morbidity since I have not been treated for it during hte last 2 years. I am going to call Aetna tomorrow to confirm. It's all so confusing!!!