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    123

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

    • Eve411

      Eve411

      April Surgery
      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
      Thanks
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
      · 0 replies
      1. This update has no replies.
    • KeeWee

      KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      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.
      · 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!

    ×