2 years of weight requirements

[Crosby 303]

I am in the first month of my required 6 month pre surgery requirements. As typical I am required to obtain 2 year weight documentation. I am in the process of getting a case manager through Aetna but would like some others experiences.

My current BMI is 46 but it has been much lower over the last two years. ( I was over 320 5 years ago and lost 135 pounds over 2 years. I started regaining slowly, lost 40 again and ultimately regained to 280.) I am wondering if having a lower BMI will hurt me? My only comorbidity is acid reflux. My main weight related medical issues are mobility related.

Secondly I have only been with my current PCP one year. Prior to that I had not seen my previous PCP in a year. But I had regularly seen an Orthropedic surgeon over that time. I had also attended WW but online only. When I called my insurance I was told the orthropedic doctors weights would not count since it was not weight related. The rep I talked admitted she was not sure though. At that point I decided I needed a Case Manager. Any insight where others got their two years of weight recordings from when PCP was not an option for entire period.

[Marathongirl 106]

I had a 3 month waiting period. However, I started at the surgeons office. I had a visit with their nutritionist every month, where I was weighed, talked about the surgery and healthy eating habits. I didn't use my PCP or a case manager. The surgeon documented everything and sent it all to my insurance company.

[Crosby 303]

I had a 3 month waiting period. However, I started at the surgeons office. I had a visit with their nutritionist every month, where I was weighed, talked about the surgery and healthy eating habits. I didn't use my PCP or a case manager. The surgeon documented everything and sent it all to my insurance company.

So you were not required by insurance to give a two year weight history? This is standard for aetna.

The other requirements I mentioned are due to insurance. The case manager is simply someone with Aetna to follow me and be a contact for any insurance issues. I am just concerned that my fluctuating weight over the last 2 years will affect my approval.

[Mayaresearchmom 104]

You should be able to get copies of your records from both of your PCP's. Simply go by their office and ask for a medical records release form. If the office has electronic medical records, then you can ask if they can simply print out a vital signs report for that time period that includes your weights and BMI. You can either have the records sent directly to your insurance, or released to you. There may be a fee if they are released to you, but they will usually release them to the insurance at no cost. Your insurance may have a release that they get you to sign so that they can request the records themselves.

Edited June 20, 2014 by Mayaresearchmom

[Crosby 303]

You should be able to get copies of your records from both of your PCP's. Simply go by their office and ask for a medical records release form. If the office has electronic medical records, then you can ask if they can simply print out a vital signs report for that time period that includes your weights and BMI. You can either have the records sent directly to your insurance, or released to you. There may be a fee if they are released to you, but they will usually release them to the insurance at no cost. Your insurance may have a release that they get you to sign so that they can request the records themselves.

I understand HOW to get them ...But there are no records to be gotten from previous pcp. As I noted I did not see the previous pcp in that timeframe. Current PCP is easy.

[Mayaresearchmom 104]

Ohhhh, sorry, I missed that part about not seeing the PCP. If you were on weight watchers or any other program like that where you weighed in, they might let you use those records. That's what I used for part of mine. Or if your ortho doc weighed you during that time, I would request copies of those weights.

Edited June 20, 2014 by Mayaresearchmom

[Crosby 303]

Ohhhh, sorry, I missed that part about not seeing the PCP. If you were on weight watchers or any other program like that where you weighed in, they might let you use those records. That's what I used for part of mine. Or if your ortho doc weighed you during that time, I would request copies of those weights.

No go on WW since it was online and they said no to Orthropedic records.( I think that was a wrong answer though.) That's why I requested case manager..need some internal guidance.

[Marathongirl 106]

I had a 3 month waiting period. However, I started at the surgeons office. I had a visit with their nutritionist every month, where I was weighed, talked about the surgery and healthy eating habits. I didn't use my PCP or a case manager. The surgeon documented everything and sent it all to my insurance company.

So you were not required by insurance to give a two year weight history? This is standard for aetna.

The other requirements I mentioned are due to insurance. The case manager is simply someone with Aetna to follow me and be a contact for any insurance issues. I am just concerned that my fluctuating weight over the last 2 years will affect my approval.

No, but I have cigna insurance. So, I guess its just a bit different. I'm sorry you have to go through all of that! You would think since the CDC declared obesity as a disease, insurance companies would be willing to help. I hope that everything works out for you.

[countrygirl 84]

I had a 3 month waiting period. However, I started at the surgeons office. I had a visit with their nutritionist every month, where I was weighed, talked about the surgery and healthy eating habits. I didn't use my PCP or a case manager. The surgeon documented everything and sent it all to my insurance company.

My Aetna also had 3 month waiting period & 2yr pcp/diet des letter w/dates of each month I was there plus letter from PvP giving his reasons I needed the surgery & 1st letter approval from insurance company,then surgery 3 weeks later. Best decision ever.

Edited June 22, 2014 by countrygirl

[Crosby 303]

I had a 3 month waiting period. However, I started at the surgeons office. I had a visit with their nutritionist every month, where I was weighed, talked about the surgery and healthy eating habits. I didn't use my PCP or a case manager. The surgeon documented everything and sent it all to my insurance company.

My Aetna also had 3 month waiting period & 2yr pcp/diet des letter w/dates of each month I was there plus letter from PvP giving his reasons I needed the surgery & 1st letter approval from insurance company,then surgery 3 weeks later. Best decision ever.

My Aetna has a 3 month and 6 month schedule but that is based on recommendations from the surgeon. My surgeon does the 6 months across the board it seems. I am okay with that as it gives me time to save more money for the costs above what my plan will cover. Also Decembet/January is really the perfect time of the year for the surgery for me. It's this two year thing that is the problem. I was hoping to hear from aetna about a case manager on Friday but nothing. Even if it means I have to wait till next Spring I just want some more clarification.