Jump to content
×
Are you looking for the BariatricPal Store? Go now!
$99 Yearly Supply Alert! 🎉 "1 per Day!" Bariatric Multivitamins

BMI Requirements for Aetna

mommyluv6

By mommyluv6, in Insurance & Financing

Recommended Posts

Peggy D    124

Peggy D
Posted

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

Congratulations!

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

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!!!

Share this post

Link to post
Share on other sites

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. :-/

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

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

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

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?

Share this post

Link to post
Share on other sites

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!

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

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 ????

Share this post

Link to post
Share on other sites

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.

Share this post

Link to post
Share on other sites

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...

Share this post

Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Go To Topic Listing Insurance & Financing

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    Bariatric Forums

    For Patients

    Health Professionals

    Search Surgeons

    Bariatric Surgeons: Want to research a weight loss surgery surgeon? Enter their last name below to start!

    ×