Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Impatiently waiting for Aetna



Recommended Posts

I thought Aetna required a BMI of over 40 or a BMI under 40 with 2 co-morbids. But by reading this thread, it sounds like it was more complicated than that.

Hi Jensnewjourney,

I know several people who were approved quickly and easily by Aetna. Several of us have had difficulty, some did not have a weight history. Or meet all the requirements in bulletin 0157. If you meet all the requirements there you will be okay. If they do deny, you will have grounds for an appeal. Don't worry until it happens. It is taking me more time, but I know I will get there. Good luck.

Share this post


Link to post
Share on other sites

Hi Jensnewjourney, I know several people who were approved quickly and easily by Aetna. Several of us have had difficulty, some did not have a weight history. Or meet all the requirements in bulletin 0157. If you meet all the requirements there you will be okay. If they do deny, you will have grounds for an appeal. Don't worry until it happens. It is taking me more time, but I know I will get there. Good luck.

Per the check list my MD group provided, if I am able to check off each item, and I'm certain I can, I'll be approved. But, anything is possible I suppose. Fingers crossed! I won't submit til Feb. nervous but mostly optimistic right now. :). Thank you for your input!!!!

Share this post


Link to post
Share on other sites

Hello. New to this. Haven't even called insurance yet. After reading all of this about Aetna, I'm now very worried. My BMI is about 43 and I was just put on metformin due to possibly being pre-diabetic. I'm on the Water pill for high blood pressure and I've had serious issues with back and neck pain due to muscular skeletal issue. (most likely my ginormous ta-tas) From what I'm reading, these may not be enough issues to get approval for the sleeve surgery that I really want. What kind of things will I have to do in order to get approved for this surgery? Anything I can do before even contacting the insurance company or docs? Any info would be greatly appreciated. Thank you in advance.

Share this post


Link to post
Share on other sites

If you have a BMI over 40 documented for 3 yrs straight, you should be golden. Aetna approved me and my BMI even dropped below 40 (to gasp: 39!) 2 years back. Thank goodness for that hypertension in my history (sarcasm... kinda.)

Hello. New to this. Haven't even called insurance yet. After reading all of this about Aetna, I'm now very worried. My BMI is about 43 and I was just put on metformin due to possibly being pre-diabetic. I'm on the Water pill for high blood pressure and I've had serious issues with back and neck pain due to muscular skeletal issue. (most likely my ginormous ta-tas) From what I'm reading, these may not be enough issues to get approval for the sleeve surgery that I really want. What kind of things will I have to do in order to get approved for this surgery? Anything I can do before even contacting the insurance company or docs? Any info would be greatly appreciated. Thank you in advance.

Share this post


Link to post
Share on other sites

I really hope so. What will be required of me by Aetna? I reading sleep studies and psych evals, whats a NUT eval? Thanks.

If you have a BMI over 40 documented for 3 yrs straight, you should be golden. Aetna approved me and my BMI even dropped below 40 (to gasp: 39!) 2 years back. Thank goodness for that hypertension in my history (sarcasm... kinda.)

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

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

    • NovelTee

      I'm not at all hungry on this liquid pre-op diet, but I miss the sensation of chewing. It's been about two weeks––surgery is in two days––and I can't imagine how I'll feel a couple of weeks post-op. Tonight, I randomly stumbled upon a mukbang channel on YouTube, and it was strangely soothing... is it just me, or is this a thing? 
      · 1 reply
      1. NickelChip

        I actually watched cooking shows during my pre-op, like Great British Baking Show. It was a little bizarre, but didn't make me hungry. I think it was also soothing in a way.

    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 2 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

    • Aunty Mamo

      Tomorrow marks two weeks since surgery day and while I'm feeling remarkably well and going about just about every normal activity, I did wind up with a surface abscess on on of my incision sights and was put on an antibiotic that made me so impacted that it took me more than two hours to eliminate yesterday and scared the hell out of me. Now there's Miralax in all my beverages that aren't Smooth Move tea. I cannot experience that again. I shouldn't have to take Ativan to go to the lady's. I really looking forward to my body getting with the program again. 
      I'm in day three of the "puree" stage of eating and despite the strange textures, all of the savory flavors seem decadent. 
      I timed this surgery so that I'd be recovering during my spring break. That was a good plan. Today is a state holiday and the final day of break. I feel really strong to return to school tomorrow. 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
      For second breakfast on workdays, I will have a low-fat yogurt with two tablespoons of PBFit and two teaspoons of no sugar added dried cherries. I will have ingested 35-45 grams of protein at this point between the two breakfasts, with 250-285 calories, and about 20 carbs.
      For second breakfast on non-workdays, I will prepare two servings of plain, instant oatmeal with a tablespoon of an olive oil-based spread. This means I will have had 34 grams of protein, 365 calories, and 38 carbs. Non-workdays are when I am being very active with training sessions, so I allow myself more carbohydrate fuel.
      Snacks on any day are always mixed nuts, even when I am travelling. I will have 0.2 cups of a blend that I make myself. It consists of dry roasted peanuts, cashews, pumpkin seeds, sunflower seeds, pistachios, and Brazil nuts. This is 5 grams of protein, 163 calories, and 7 carbs.
      Breakfast and snacks have been the easiest to nail down. Lunch and dinner have more variables, and I prepare enough for leftovers. I concentrate on protein first, and then add vegetables. Typically tempeh, tofu, or Field Roast products with roasted or sautéed vegetables. Today, I will be eating leftovers from last night. Two ounces of tempeh with four ounces of roasted vegetables that consist of red and yellow sweet peppers, sweet potatoes, small purple potatoes, zucchini, and carrots. I will add a tablespoon of olive oil-based spread, break up 3 walnuts to sprinkle of top, and garnish with two tablespoons of grated Parmesan cheese. This particular meal will be 19 grams of protein, 377 calories, and 28 grams of carbs. Bear in mind that I do eat more carbs when I am not working, and I focus on ingesting healthy carbs instead of breads/crackers/chips/crisps.
      It's a helluva journey and I'm thankful to be on it!
       
      · 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

    ×