Aetna Insurance with 35.5 BMI and Sleep Apnea

[NY Bandster 1]

Hi all,

I have just joined this Forum today and have learned a lot from all of you....THANKS!! I'm wondering if any of you have experience with Aetna Insurance with a BMI that was less than 40 with a co-morbid condition. I know that they are requiring a two year history, but I'm not sure if my BMI had to be over 35 for these two years and if my sleep Apnea had to be diagnosed two years ago. I have struggled with my weight for my whole life but luckily I haven't had any health issues - until now - Severe sleep Apnea, High Cholesterol, Knee and Back Pain. I need to get this done and re-claim my life!! Any information and sharing of experiences would be GREATLY appreciated!!

[Bryn 3]

I have Aetna insurance but all plans/policies are different. And I had the sleeve surgery, but I have seen Aetna approve LapBand patients with a BMI of less than 40. I would review their obesity bulletin policy or call a rep from the insurance company. they'll email you with a list of the requirements.

Also, don't be discouraged just because the policy says something and you don't fit that requirement or your doctor doesn't. sometimes insurance companies oversee things or they let something slide etc. some insurance companies are very forgiving and will accept one thing over another.

good luck to you on this journey. it's an exciting one!

[NY Bandster 1]

Thanks for responding!! I am excited about starting on this journey but also nervous about the insurance denying and being disappointed. I will try though!!

I have Aetna insurance but all plans/policies are different. And I had the sleeve surgery, but I have seen Aetna approve LapBand patients with a BMI of less than 40. I would review their obesity bulletin policy or call a rep from the insurance company. they'll email you with a list of the requirements.

Also, don't be discouraged just because the policy says something and you don't fit that requirement or your doctor doesn't. sometimes insurance companies oversee things or they let something slide etc. some insurance companies are very forgiving and will accept one thing over another.

good luck to you on this journey. it's an exciting one!

[sherrypep 91]

I am in the same boat as you. I also have Aetna and a BMI of 36 with Diabetes, high cholesteral, hip and leg pain, etc... I just got my 2 year weight history and my BMI two years ago was 34.5 with no comorbidities. I have finished all my appointment and meet my surgeon on July 12 to schedule my surgery. I am so scared I will get denied. You are not alone. Good luck. I have heard that Aetna is quick to say yes or no and after appeals they do finally cave. We will see. I am hoping for an August banding.

[NY Bandster 1]

I wish you luck! Please stay in touch and let me know how everything turns out. I saw the surgeon on Friday and am hoping for a September surgery date. I have a few more tests to complete before they will submit to Aetna. I am concerned that I dropped below the 35 BMI during the 6 month diet history. I'm hoping that doing the right thing doesn't wind up hurting me. Although I did find some records with a 35 BMI 2 years ago, I didn't have the co-morbidity until this May. I'm so anxious about all of this and can't sleep at night worrying!!! The woman in the surgeon's office that works on the insurance said she wasn't sure what to expect since she has never worked with anyone with such a low BMI that had Aetna. I was hoping to get a few more responses from people that have been in the same boat as we are. If you find anything else, please let me know and I will do the same!!!

I am in the same boat as you. I also have Aetna and a BMI of 36 with Diabetes, high cholesteral, hip and leg pain, etc... I just got my 2 year weight history and my BMI two years ago was 34.5 with no comorbidities. I have finished all my appointment and meet my surgeon on July 12 to schedule my surgery. I am so scared I will get denied. You are not alone. Good luck. I have heard that Aetna is quick to say yes or no and after appeals they do finally cave. We will see. I am hoping for an August banding.

[kll724 3,055]

My son has just finished his 6 month diet, and had to get the records for last 2 years from his Family practioner, but he was approved within 1 week of the insurance company receiving his records. he has Aetna, and is border-line, but has 1 co-morbidy. He has high bloods pressure. He is 40 BMI exactly.But, I am sure that he was not that high for the last few years, so good luck. They may except you if you have those co-morbidy they want. Karen

[girly831 8]

Has anyone been denied by Aetna, filed an appeal and they approved the surgery? Just wondering how good my chances are of getting approved after denial. I've already started the ball rolling with asking my Dr to submit a Medical Necessity statement.

[NY Bandster 1]

Thanks for the info Karen. I'm keeping my fingers crossed!!

My son has just finished his 6 month diet, and had to get the records for last 2 years from his Family practioner, but he was approved within 1 week of the insurance company receiving his records. he has Aetna, and is border-line, but has 1 co-morbidy. He has high bloods pressure. He is 40 BMI exactly.But, I am sure that he was not that high for the last few years, so good luck. They may except you if you have those co-morbidy they want. Karen

[SIPS in Seattle 345]

Has anyone been denied by Aetna, filed an appeal and they approved the surgery? Just wondering how good my chances are of getting approved after denial. I've already started the ball rolling with asking my Dr to submit a Medical Necessity statement.

I was denied twice. Had to get help through Obesitylaw.com with my surgeon's recommendation.

I was at like 38 BMI, mild apnea, lower back pain (already had spinal fusion surgery) but they denied me for not having 2 years documentation that i was over 40 BMI.... they said my apnea wasn't enough.

Just make sure you have everything documented and gather as much medical information as you can about your weight.

Good Luck!

[dropsizes 2]

Hi all,

I have just joined this Forum today and have learned a lot from all of you....THANKS!! I'm wondering if any of you have experience with Aetna Insurance with a BMI that was less than 40 with a co-morbid condition. I know that they are requiring a two year history, but I'm not sure if my BMI had to be over 35 for these two years and if my sleep Apnea had to be diagnosed two years ago. I have struggled with my weight for my whole life but luckily I haven't had any health issues - until now - Severe sleep Apnea, High Cholesterol, Knee and Back Pain. I need to get this done and re-claim my life!! Any information and sharing of experiences would be GREATLY appreciated!!

Hi, I have Aetna and all they needed from me was a six month diet history. I have very mild sleep apnea and some leg pain. My GP was very helpful in writing a letter just in case I needed it as back up for the op. Please Please Check your Aetna Plan and Call Them!! Sometimes things change and insurance covers Lap Band but they forget to tell us as mine did. I read and called and did all the paper work and thank goodness they did cover it once I paid my deduct . I did how ever need to use a hospital of excellence in order to use Aetna.

I wish you best of luck and hope you get your wish.

Stay well.

Mary

[NY Bandster 1]

Mary,

Was your BMI 40 or higher?

Thanks,

Stacy

Hi, I have Aetna and all they needed from me was a six month diet history. I have very mild sleep apnea and some leg pain. My GP was very helpful in writing a letter just in case I needed it as back up for the op. Please Please Check your Aetna Plan and Call Them!! Sometimes things change and insurance covers Lap Band but they forget to tell us as mine did. I read and called and did all the paper work and thank goodness they did cover it once I paid my deduct . I did how ever need to use a hospital of excellence in order to use Aetna.

I wish you best of luck and hope you get your wish.

Stay well.

Mary

[NY Bandster 1]

Got my approval....so excited!! Thanks all for your info and input!