AETNA BMI BMI Requirements for Aetna

[mommyluv6 2]

Since I was a teenager I have had a BMI between 35 and 39 with a few good weight loss runs that put me below and a few pregnancies that put me over. I have no co-morbities but my Mom died at 49 and my Dad died at 51 from obesity related issues. I am 36. This past year I have hovered between 40 and 41. Last year 2012, I was pregnant and my only weigh ins were while pregnant and my post partum visit weigh in I only gained 25 lbs (1) can I use any of those weigh ins to count? (2) my BMI was only 38 still morbidly obese but not above 40. In 2011 while I do have non-pregnancy weights my BMI was still only around 38. Has any one used pregnancy weights (first visit or post-partum visit) and has any one been approved not proving a BMI of 40 over the last 24 months?

TIA

[Baeball Mom 104]

I think I would talk to your doctor. Because of your family history, they might be able to word it so that you don't have to have a BMI of 40.

[LMarie 26]

Aetna approved me in 1 day and I did not have a bmi of 40 for 2 years..

[sonya139 95]

LMarie, that's great!!

[LivingForGod 111]

Aetna told me they don't accept weights while being pregnant. So that may be something you want to check on!

BE BLESSED!!

[LivingForGod 111]

Aetna told me they don't accept weights while being pregnant. So that may be something you want to check on!

BE BLESSED!!

[LivingForGod 111]

Aetna told me they don't accept weights while being pregnant. So that may be something you want to check on!

BE BLESSED!!

[Peggy D 123]

Here is the link to Aetna's bariatric surgery criteria.

http://www.aetna.com/cpb/medical/data/100_199/0157.html

[bigbeauty78 27]

Peggy do you know the criteria for Bcbs Florida?

[Peggy D 123]

No, I don't, sorry. I only know Aetna because that's the insurance I have & they sent me the link. You might try a Google or Bing search for BCBS bariatric surgery criteria, surgery for morbid obesity, medical necessity criteria & similar & see what comes up. I did find a few for BCBS when I was looking to compare criteria from different companies, but not Florida.

Remember that this is medical necessity criteria, not insurance contract coverage. First, whatever the service is needs to be covered by the contract. Then, even if it is medically necessary, if the contract excludes it, it would not be covered. Unfortunately, bariatric surgery is excluded in the contracts many employers purchase. That was always one of the most difficult things to try to explain when I worked as a clinical review nurse. Hopefully, now that obesity is classified as a disease in & of itself, surgical treatment will be an option for many more people.

[blessed252 9]

No' date=' I don't, sorry. I only know Aetna because that's the insurance I have & they sent me the link. You might try a Google or Bing search for BCBS bariatric surgery criteria, surgery for morbid obesity, medical necessity criteria & similar & see what comes up. I did find a few for BCBS when I was looking to compare criteria from different companies, but not Florida.

Remember that this is medical necessity criteria, not insurance contract coverage. First, whatever the service is needs to be covered by the contract. Then, even if it is medically necessary, if the contract excludes it, it would not be covered. Unfortunately, bariatric surgery is excluded in the contracts many employers purchase. That was always one of the most difficult things to try to explain when I worked as a clinical review nurse. Hopefully, now that obesity is classified as a disease in & of itself, surgical treatment will be an option for many more people.[/quote']

Peggy....I hve aetna.hw long did it tke fr u to get approve?

[Peggy D 123]

I found out in less than a week. I actually received a call from a case manager at Aetna first. Some how the info got sent to her directly from the medical director or review team rather than going to the department that sends out the notices to patients & providers first. I think it was a day or two later when I got my approval letter in the mail.

[nh20013 15]

Since I was a teenager I have had a BMI between 35 and 39 with a few good weight loss runs that put me below and a few pregnancies that put me over. I have no co-morbities but my Mom died at 49 and my Dad died at 51 from obesity related issues. I am 36. This past year I have hovered between 40 and 41. Last year 2012' date=' I was pregnant and my only weigh ins were while pregnant and my post partum visit weigh in I only gained 25 lbs (1) can I use any of those weigh ins to count? (2) my BMI was only 38 still morbidly obese but not above 40. In 2011 while I do have non-pregnancy weights my BMI was still only around 38. Has any one used pregnancy weights (first visit or post-partum visit) and has any one been approved not proving a BMI of 40 over the last 24 months? TIA[/quote']

Hi I am at a 41.5 bmi and have hypertension just diagnosed this year, my mom died at 57 from colon cancer and had diabetes was overweight. however my weight gain has been this past year so the past 2 years I was under 40 but over 35 with no comorbidities, and on august 29th Aetna denied my claim. I am going to have a sleep study done and have my appeal letter ready to re send. I'm not giving up that easily.

[sonya139 95]

Hi I am at a 41.5 bmi and have hypertension just diagnosed this year, my mom died at 57 from colon cancer and had diabetes was overweight. however my weight gain has been this past year so the past 2 years I was under 40 but over 35 with no comorbidities, and on august 29th Aetna denied my claim. I am going to have a sleep study done and have my appeal letter ready to re send. I'm not giving up that easily.

Good....don't give up!

[blessed252 9]

Thanks Peggy...I pray mines go tht smooth...