AETNA & BMI'S?

[Beachmamaof4 4]

Hello, been a roller coaster of a ride this week re: gastric sleeve journey. Good news: my husband has come around, and said he will fully support my decision to have the sleeve. So relieved!

Bad news: After I've accepted the changes, mentally, and invested a lot of time w/lab work, Upper GI, psych eval, and meeting w/the dietician....there may be a snag with insurance! So, apparently, Aetna has a requirement that you have had a BMI of 40 for at least 2 years. Currently, I have a BMI of 40. However, my BMI for the last couple years has been between 33-35, well, actually as I'm thinking about it...probably 37-38. I asked the gal at the Dr's office who schedules the surgery if we could go back to 2002. She said we could try, but most likely, Aetna will want the weights from more recent times. Awaiting Dr's records from OB/gyn after having a baby in 2010---but I think it will fall just shy--like I'd have a BMI of 39.

Now, am I backwards in this logic? Wouldn't showing a BMI of 40 from 2002 give more credibility to the fact I've been struggling with weight this long, have been able to lose it, but I gain it back, which is why I need something this drastic???

So, my question is...have any of you with Aetna had luck submitting BMI/weights from 10-11 years ago? Or, anyone with Aetna have luck submitting a current BMI of 40 but in last couple years, records showed a BMI of 38 or 39 (no comorbid conditions---just asthma and immune deficiency which I don't think they consider)? Thanks!

[brandyrn73 13]

I have Aetna and was denied by them TWICE. I have a BMI of 40 and sleep apnea. For the past two years my BMI was around 38-39. They are sticklers on their requirements. I was denied the first time for BMI over 35 but no co morbid conditions. They second time I had reached 40 with sleep apnea but because I hadn't had the comorbidity for two years as well I was denied.

I'm sick of Aetna and their games. Dropping them during my next enrollment. Good luck!

[Beachmamaof4 4]

Wow! Ok, I guess my ins. coord. was right. So, the second time when you had a BMI of 40 and sleep apnea, did you wait the 2 yrs for comorbidity? So, you haven't had the surgery yet? Or, were you able to finally get approved? Sorry to hear that!

I have Aetna and was denied by them TWICE. I have a BMI of 40 and sleep apnea. For the past two years my BMI was around 38-39. They are sticklers on their requirements. I was denied the first time for BMI over 35 but no co morbid conditions. They second time I had reached 40 with sleep apnea but because I hadn't had the comorbidity for two years as well I was denied.

I'm sick of Aetna and their games. Dropping them during my next enrollment. Good luck!

[brandyrn73 13]

I got approved through my secondary insurance soon after the diagnosis of sleep apnea. I don't wish to have a co morbidity but truthfully it's been a god send. I got approved (finally) and I feel so much better since wearing my cpap. I think it's stupid you have to have a co morbidity for two years. If you have it you have it. What makes a difference if you have diabetes or sleep apnea 1 month or 10 years?!

Stupid Aetna.

[nh20013 15]

I got approved through my secondary insurance soon after the diagnosis of sleep apnea. I don't wish to have a co morbidity but truthfully it's been a god send. I got approved (finally) and I feel so much better since wearing my cpap. I think it's stupid you have to have a co morbidity for two years. If you have it you have it. What makes a difference if you have diabetes or sleep apnea 1 month or 10 years?! Stupid Aetna.

Wow I am so in these shoes right now it's horrible!!! They have denied me for the same exact thing even though now am at a 41.5 with HB pressure but not for the past two years. It's so frustrating I was really hoping to have this done in October ... I started everything in May

[Beachmamaof4 4]

Wow I am so in these shoes right now it's horrible!!! They have denied me for the same exact thing even though now am at a 41.5 with HB pressure but not for the past two years. It's so frustrating I was really hoping to have this done in October ... I started everything in May

Don't give up! I am shocked, but insurance approved me the first time! I was sure they would say no because I clearly didn't meet guidelines they provided me in the clinical bulletin. My unsolicited advice...i had several of my doctors write letters on my behalf stating how it would help the health problems I did have (even though they weren't one of the 3 conditions insurance mentioned). And, I sent pictures over the years to show this has been a long-term thing. I think it helped to see a patient as a real person w/my kids, not just name on paper. Best of luck to you.