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BMI Requirements for Aetna

mommyluv6

By mommyluv6, in Insurance & Financing

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Peggy D    123

Peggy D
Posted

Approve in 2 buss days.Sugery Oct 29th...So excited!

Congratulations!

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Bethylou    4

Bethylou
Posted

This is my first post. My Dr. submitted my paperwork about two weeks ago. Mine is still "pending." I had to wait a year after I got married to be eligible for Aetna to cover it. I'm soooo nervous. What causes a pre-cert to remain pending? Thanks for any and all replies.

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nh20013    15

nh20013
Posted

This is my first post. My Dr. submitted my paperwork about two weeks ago. Mine is still "pending." I had to wait a year after I got married to be eligible for Aetna to cover it. I'm soooo nervous. What causes a pre-cert to remain pending? Thanks for any and all replies.

I would call and make sure it's been submitted my doctors office had called and opened a case but had not submitted the paperwork I kept calling Aetna and they would say it's pending until one Rep explained it to me I called the doctors office and sure enough paperwork had not been submitted. After they submitted it took a week....good luck hope you get your approval!!!

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Bethylou    4

Bethylou
Posted

I would call and make sure it's been submitted my doctors office had called and opened a case but had not submitted the paperwork I kept calling Aetna and they would say it's pending until one Rep explained it to me I called the doctors office and sure enough paperwork had not been submitted. After they submitted it took a week....good luck hope you get your approval!!!

They submitted the paperwork on Sept. 12 and received the clinicals on the 16th. Said usual turnaround time is 15 days after that. I'm so nervous about getting approved. I tried almost 10 yrs ago and was denied for having no major health issues. I'm now diabetic, so maybe I'm good to go now? Was hoping to have it done before I had health problems, but I guess insurance doesn't work like that. :-/

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nh20013    15

nh20013
Posted

They submitted the paperwork on Sept. 12 and received the clinicals on the 16th. Said usual turnaround time is 15 days after that. I'm so nervous about getting approved. I tried almost 10 yrs ago and was denied for having no major health issues. I'm now diabetic' date=' so maybe I'm good to go now? Was hoping to have it done before I had health problems, but I guess insurance doesn't work like that. :-/[/quote']

Wow interesting you say that, they denied me too for 2 yr history with no comorbids even though I have developed hypertension now, so I'm appealing went and had a sleep study and got sleep apnea DX so keeping my fingers crossed when I submit a second time. You should not have any issues getting approved now if you have diabetes. That's exactly what I'm trying to avoid SMH that part of my appeal it's a shame they rather treat comorbids than save the money by approving surgery.

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bosoxgirl1966    20

bosoxgirl1966
Posted

Hi

I have Aetna POS II and according to their clinical policy bulletin BMI greater than 40 or less than 40 with comorbidities

My surgeons office sent my paperwork in for approval ON Thursday afternoon. I am a wreck waiting to hear. My BMI is 39.8 but I have sleep apnea and high blood pressure

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Bethylou    4

Bethylou
Posted

I know! It is so frustrating and nerve-wracking. I see where people got approval in a week or even two days. Can't help but be nervous. It's so ironic that my diabetes was diagnosed just 7 mos ago. I'm type 2 but on both insulin sand oral meds. I hope your appeal is successful. I remember 10 years ago when I got the call that it was denied. I boo-hooed like a baby and was depressed for so long. I had gone through all the tests and dr visits (even being diagnosed with sleep apnea and put on a CPAP, but it wasn't enough.) Aetna said I should know something next week.

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nh20013    15

nh20013
Posted

Hi I have Aetna POS II and according to their clinical policy bulletin BMI greater than 40 or less than 40 with comorbidities My surgeons office sent my paperwork in for approval ON Thursday afternoon. I am a wreck waiting to hear. My BMI is 39.8 but I have sleep apnea and high blood pressure

How about your past 2 yr history did it meet requirements?

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Bethylou    4

Bethylou
Posted

Not a clue. I would think if it didn't they would've told me. This is the first I'm hearing of that. What are the requirements!

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Bethylou    4

Bethylou
Posted

Not a clue. I would think if it didn't they would've told me. This is the first I'm hearing of that. What are the requirements!
. Sorry about the exclamation point. That was supposed to be a question mark.

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nh20013    15

nh20013
Posted

. Sorry about the exclamation point. That was supposed to be a question mark.

I meant they require you to either be at 40 bmi for 2 yrs or 35-40 with comorbids... I only had 35-40 with no comorbids so I was denied ????

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Bethylou    4

Bethylou
Posted

I didn't have any medical history in that length of time. I was previously married and divorced. Had no insurance for many years, so I didn't go to the doctor. :-/ Remarried a year ago and had to wait for a year to elapse before I was eligible under my husband's plan. Wasn't told anything about the 2 year BMI.

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mommyluv6    2

mommyluv6
Posted

Well I have now been diagnosed with sleep apnea and PLMD. I just wonder if this will help our if I will have to have the diagnosis for 24 months before I can get approved. I got my weight records from 2011 to now and my BMI never went under 35 so in theory I meet all the Aetna requirements. I just pray it's enough...

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