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Aetna Weight- Which Weight Is Used?

SkinnyWannaBe

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SkinnyWannaBe    6

SkinnyWannaBe
Posted

I have been approved by Aetna (h.m.o.), have gone through further testing (treadmill stress test/ cardiogram), and have a few more appts before surgery. I am right on the border of 35 bmi (w/ comorbidities) & my weight has been dropping due to a new state of mind & the heat. Which is the weight that aetna uses? The initial weigh in, or the day of surgery? Has anyone been denied on the day of surgery for not weighing enough?

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Chimera    644

Chimera
Posted

I am not sure about Aetna - but my insurance BCBS of Illinois used my starting weight and BMI.

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Neese    75

Neese
Posted

I went through Aetna and it was your starting weight. Good luck.

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doxieville    799

doxieville
Posted

I have Atena; it's your starting date. Day 1 when all this started. :-).

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Raven21    121

Raven21
Posted

It is the weight your bariatric center submits. I verified this repeatedly and they promised me the only weight they will submit is the one from the initial consult.

I don't think the insurance company specifies bc I have Aetna also.

How long did your approval take?

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SkinnyWannaBe    6

SkinnyWannaBe
Posted

Hi Raven21: After going through all of the classes- my approval took about 1.5 weeks. I was hanging on the edge of my seat wondering the whole time.

How long did yours take?

I am more nervous now with the rest of it- for every hoop that I jump through, there always seems to be many more- and it gives me anxiety- wondering if the dream is to all come crashing down at any moment, not to go through... but I am sure everyone on here feels that way!!

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Raven21    121

Raven21
Posted

I'm in the midst of it right now.

I'm required to do 90 days of a multi disciplinary program which includes 3 psych, 3 nutrition, 3 PCP visits, and an exercise consult.

I've had one of each so far.

I should be done and able to submit for approval on November 17th.

I'm hoping for a December surgery date!

Did you not have this same process?

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SkinnyWannaBe    6

SkinnyWannaBe
Posted

Mine was a bit different- I had a 6 month nutrition, and then I had to attend some classes and a psych eval before I could submit for an approval.

I hope you get your surgery date in dec! I hope to get one soon- as soon as I can get the scheduler to return my phone call :)

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Go To Topic Listing POST-Operation Weight Loss Surgery Q&A

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      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
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      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
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