Just received a copy of my medical records and it shows my BMI was below 35 during the 2 year period

[Ladiec2 74]

I requested a copy of my medical records and just received them yesterday. It shows my BMI was below 35 during the 2 year period requirement.
I have AETNA insurance and one of the requirements for the surgery is: Surgical treatment of morbid obesity (bariatric surgery) – a condition that has persisted for at least 2 years in which an individual has a body mass index (BMI) exceeding 40 or a BMI greater than 35 in conjunction with documented significant co-morbid conditions (such as coronary heart disease, type 2 diabetes mellitus, obstructive sleep apnea or refractory hypertension). My BMI up through July 2012 is 34.6 and my next appt. which was in 4/2013 it was 36.3 and has been 36.3 up through this month. Should I be worrried that my BMI was below 35 during that period? I really, really need this surgery.

[jessiquoi 623]

instead of giving the surgeon the records, can you have your PCP write a letter stating that you are eligible? mine did and it got through without giving dates and specifics.

[dede0314 356]

^{I don't think you need two years of history anymore. Their requirements were revised on 8/12.}

^{Must meet either 1 (adults) or 2 (adolescents):}

1. ^{For adults aged 18 years or older, presence of persistent severe obesity, documented in contemporaneous clinical records, defined as any of the following:}

   1. ^{Body mass index (BMI) (see appendix) exceeding 40; or}

   2. ^{BMI greater than 35 in conjunction with any of the following severe co-morbidities:}

      1. ^{Clinically significant obstructive sleep apnea (i.e., person meets the criteria for treatment of obstructive sleep apnea set forth in CPB 0004 - Obstructive Sleep Apnea in Adults); or}
      2. ^{Coronary heart disease, with objective documentation (by exercise stress test, radionuclide stress test, pharmacologic stress test, stress echocardiography, CT angiography, coronary angiography, heart failure or prior myocardial infarction); or}
      3. ^{Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite concurrent use of 3 anti-hypertensive agents of different classes); or}
      4. ^{Type 2 diabetes mellitus}

[jjinWA 511]

I requested a copy of my medical records and just received them yesterday. It shows my BMI was below 35 during the 2 year period requirement.

I have AETNA insurance and one of the requirements for the surgery is: Surgical treatment of morbid obesity (bariatric surgery) – a condition that has persisted for at least 2 years in which an individual has a body mass index (BMI) exceeding 40 or a BMI greater than 35 in conjunction with documented significant co-morbid conditions (such as coronary heart disease, type 2 diabetes mellitus, obstructive sleep apnea or refractory hypertension). My BMI up through July 2012 is 34.6 and my next appt. which was in 4/2013 it was 36.3 and has been 36.3 up through this month. Should I be worrried that my BMI was below 35 during that period? I really, really need this surgery.

his happened to my daughter as well. She has Aetna. The surgeons coordinator said the only chance we have of getting it approved is to wait and submit after the qualify BMI date and 2 years have expired since then. For you it sounds like that would be April 2015. For my daughter, because she did not have any co-morbidities, she has to be over 40BMI for 2 years. We gave up. Going to Mexico. With Aetna they will find anything to fail you. If it is not one thing it's another. You cannot lose weight and get below required BMI... You cannot gain any weight while working with the NUT, and so on and so on.

[puttingme1st 143]

I was just approved by Aetna and it was very easy. However, they do require 2 year history. Not sure how you will get around that.

[jjinWA 511]

You don't get around the 2 year history. Period. It is their easy way of disqualifying most. But honestly just about every ins company requires the history of weight issues. So can't fault Aetna for that. Just part of the games we play and hoops we jump. If you are healthy ( no co morbidities) and your under 40 BMI you will likely have a harder time getting approval from insurance company, and most assuredly from Aetna. But as has been said in other posts, each employer plan can be very different even if all are under the Aetna name.

[Jersrose43 837]

I suggest you switch insurance if you can. Have Cigna and had no such ridiculous requirement of 2 years.

Also remember that aetna has differing policies applied dependent on what your employer purchases.

Try a spouse policy of possible. Or ask your employer what other choices you have at open enrollment