Aetna approval and fluxuation of weight

Ylissa · April 22, 2009

Long time reader, first time poster, as the phrase goes.

I have Aetna EPO, and live in NY state. I am a LPN, so I was pretty careful to do my research, contact my insurance, make sure that lap-band was covered IN MY CONTRACT, got my letter from my PCP, went to seminar at my prospective surgeons office....and then hit a hurdle.

I have been 'basically' the same weight for 9 years. I am 5'7.5 and currently 275lbs. However, the issue is, I have been pretty persistant in attempting to lose weight. I have done Atkins, WW, all that fun stuff. I tend to lose weight very quickly for a short period of time...and then crash and burn and regain it all just as quickly.

Case in point: Oct '07, I started working nights. I ate once a day, and the rest of the time consumed coffee by the gallon. I lost 68lbs in 5 months. Then I got shifted back to working days....and gained it all back in 8 months.

The surgeon's office is telling me that Aetna will most likely NOT approve me for lap banding due to the fact that I have not been a consistant weight for the last 2 years, and that I have fluxuated several dozen lbs up and down over the last decade.

Does anyone have any experience with this? Any way to fight it? I'm pretty much on my own as my PCP won't really fight for me.

Thanks!

-Ylissa

B_there · April 22, 2009

One year before I had surgery my weight was 40 lbs. lighter due to some meds I was taking. I didnt have any trouble getting approved by Aetna.

Bethanyblondie · April 22, 2009

I have Cigna insurance, but all they required was proof of my BMI being over 20 for the last 24 months, so I only sent in the medical records that had my highest weights on them. I was approved in a day and a half.

Aetna doesn't have to see all your fluctuations...just send them your highest weights recorded at any doctor appointment in the last two years. Good luck!

lisac82 · April 24, 2009

Ylissa, I have the same problem! and please fill me in if you get an answer. I finished my requirements but the only thing I am scared about is that in 07' my bmi is 38 and in 08' its 40 and I know Aetna requires a BMI of over 40 and Im nervous about them denying me. So let me know what happens, thanks :lol: