I know every insurance company is different but.... I have severe osteoarthritis (pending total knee replacement) and high cholesterol. My sleep study is scheduled. I'm not sure if I have the co-morbidities required for a BMI of 35-39. I am working hard to adjust my eating, exercise... habits now. I was 271 at my first appointment with the PA. I am now 252. The PA cautioned me against going below a BMI of 40 prior to insurance approval. I'd hate to put brakes on my momentum. Without a diagnosis of sleep apnea, would my other two diagnoses qualify me for a BMI of 35-39 ?

With Aetna, the answer is NO. My BMI was 36.1 so I was in the 35-39 group that needed comorbidities. I had high blood pressure on two medications (had to be three medications to qualify), high cholesterol (doesn't count unless you have associated documented heart disease), high A1C and glucose (but was not officially diabetic) and insurance didn't approve until I was diagnosed with sleep apnea. Aetna approves with BMI of 40 or above.

So without comorbidities, if your BMI goes below 40, insurance may not approve.

I have Aetna as well. Was approved with a bmi of 35 and 1 co morbidity (GERD). There are tons of different kinds of Aetna so one kind might approve you while another kind may not.

Edited February 16, 201511 yr by sunflowerchild