2 year history for Aetna PPO

[CurvyCat 0]

I finally had my official first consult with my Dr. last week, and talked with the insurance liasion about a week before that.

Both are saying that Aetna has gotten very strict about the 2 year history.

I've decided to do the 3-month program, much of which I have to pay for out of pocket. My Dr. warned me, though, that Aetna may still not approve me because of the lack of history.

I am going to try putting together a photo portfolio and essay like I read here that some others have done.

My BMI is over 42, I don't have any co-morbidities, and the only medical history I have is last year's physical, which has me at just under 40 BMI. I also can get my kids' birth certificates (2004 and 2007) that show me at over 40 BMI at the times of their birth, but that may not be acceptable as gain during pregnancy is expected and doesn't show a 'normal' state, weight-wise. I had a birth center birth and a home birth, so no hospital or doctor records there.

Any ideas on what I might be able to do to improve my chances of approval? If it's a lost cause, then I want to know now before I have to pay for the 3-month program so I can start working on possible ways to self-pay.

His office is also having a contest right now for a free surgery - which, of course, I entered. I'll find out later today if I'm a semifinalist. Here's hoping!

[tealeaves 0]

Hi there CurvyCat,

My surgeon told me that Aetna is a breeze to deal with, but never mentioned that they might want a two year weight history.

Aetna approved me for the three month plan. When all was said and done, they did ask for the two year history showing my weight. Well, I called my doctor and he sent me 5 years worth of history (it took them a few days, but wow, they sent some really detailed information)!! I faxed it to my surgeon's office on Dec. 11th and here I am still waiting. I just wish I would have known this during the three month wait because I could have requested my weight history from my doctor so it could have been sent it in along with all of my other paperwork for surgery approval.

I hope that the 5 year history will be good enough!! I will post as soon as I know anything!!

Good Luck!!

[btrieger 21]

The 2 year history is a breeze if you had a doctors visit in 2008. They send the 2008 from your doctor and the 2009 from their office.

I say this hoping it is as easy as my surgeons staff said it would be. My paperwork is getting submitted to Aetna on Wednesday.

[tealeaves 0]

I wanted to let you know that Aetna just approved my surgery!! :thumbup:

My surgery date is Jan. 22nd!! Pre-op appt. with Cardiologist and Nutritionist is Jan. 13th.

WOO-HOO!! I am so excited!! I am crying tears of joy!!

Have a Blessed Day... I know I am!!

[btrieger 21]

Congrats!!

[tealeaves 0]

Congrats!!

Btrieger....Thank you so much!!

Best of luck to you :thumbup:

Tealeaves :thumbup:

[CurvyCat 0]

Just wanted to say that I got my approval from Aetna today even without a strict 2 year history. Or rather, they accepted my post-partum weights in '04 and '07, plus the weights from late 2009 and early 2010.

I'm travelling a lot in May, so I'm going to try to get a mid-June surgery date. :smile:

[cunner 21]

Congratulations CurvyCat.

As breiger said, the 2 year histoy is a breeze... that is if you meet it OK. Although I had history of being above the 35 BMI (with several co morbidities) back as far as 2004 I had fallen slightly below 35 BMI about 18 months ago because I was god forbid, dieting and exercising. Even though I have put all the weight back on plus some once again, Aetna used that to deny me.

I am now starting the appeal process. I have searched here and found that some others have been successful in similar circumstances so it does give me some hope.

Once again, Congrats on you approval. :-)

[needabreak 0]

I have a story close to yours....I have Aetna PPO and I just finished my 6 month physician - supervised visit and Aetna denied me because the surgeon faxed over for my 2 year BMI a date of service for 11/2008(which is not exactly 2 years and showed my BMI at 39.6). We faxed the appeal yesterday with a date of service my physician gave us for 05/08/08 with a BMI of 41, so what are my chances of getting approved now? I am really stressed because my scheduled surgery date is May 12th

[CurvyCat 0]

Needabreak, I hope your appeal goes through, that BMI is SO close!!

My approval was a surprise to me and to my surgeon both. We fully expected to have to appeal. I sent in what amounts to a one-page essay detailing my ups and downs over my life with my initial submission, so that might have helped.

What my insurance liaison at Aetna told me, though, was that I was probably approved because I had shown in my 3-month diet that I was VERY motivated and ready to be compliant, and that that makes me a good candidate for success with the Band.... thus a good investment in Aetna's eyes.

I am not over 40 BMI now, so I'm glad they looked at it that way.