Aetna 2015 Weight Requirements

[SleevePerry 248]

Hi everyone!

I'm in the home stretch of the VSG pre-approval process and the worry that Aetna will deny me has started to creep in. I'm getting a bit panicky!

I started the process with a 41 BMI. No co-morbidities.

My 2013 and 2014 BMI was 38 (I was on Diet2Go in 2014 and Nutrisystem in 2013).

I've provided the surgical coordinator with BMI records for 2013 and 2014, but she doesn't believe they are needed. I'm not so sure. More so, I'm worried that not having a 40 BMI in 2014 and 2013 will cost me surgical approval.

Has anyone had experience with Aetna in 2015? Whatever experience you can share would be helpful.

Thanks in advance!

[wannaBthinsoon 1,634]

Hopefully your insurance co dropped that requirement. UHC did. That is a ridiculous requirement. Seriously. We (you and me and everyone else on this site) has been on a diet FOREVER...Up....DOWN....Up (again)....DOWN (again). over and over. Did you check to see if they still required past years over BMI of 40?

[SleevePerry 248]

From what I understand, the Aetna site used to indicate that 2 consecutive years of a 40 BMI was required. They now just state that a history of severe obesity is required. But that's pretty vague so I'm hoping someone on this site has recently dealt with Aetna and has a history similar to mine...

[Invictus 56]

I just started the process. I have to provide Doctor documentation that obesity has been a persistent problem. To me, that is a pretty vague definition for them to quibble about 2 or 3 BMI points. Remember, they really don't want to have to pay for this, so they are going to make it difficult

[majorsmama 91]

I've recently spoken to the bariatric "guru" at Aetna and she explained that despite changing the wording in the bulletin, they are still looking for a 2 year weight history and are requesting two years worth of weights from your PCP. Do you have any co-morbidities? If so, it shouldn't be an issue.

[SleevePerry 248]

I have a weight history for two years, just not a 40 BMI. I'm always dieting, and have needed to do so to maintain a 38 BMI. No co-morbidities as of yet, but a family history of diabetes and heart disease.

I also spoke to a weight guru there and she said a 40 BMI for 2 years wasn't specifically required, that they look at a multitude of things. So frustrating, not knowing if you are doing all of this for nothing.

[SleevePerry 248]

I'm 43 now and I had a recorded 40 BMI at age 23. I've gone up and down for 20 years, but the scale is winning, as it's getting harder and harder to keep weight off as I get older.

[wannaBthinsoon 1,634]

Do they have to be consistent years? I bet they don't. Ask about that. Last year when UHC required 3 years of history of BMI over 40 it did not have to be consistent years.

[majorsmama 91]

Aetna it does have to be consistent. They ask for the last 2 years.

[SleevePerry 248]

Have you already submitted @@majorsmama? They probably do want two years of a 40 BMI, and it probably will be an issue if I don't have it but, per the Aetna Bariatric nurse I spoke with, it's not necessarily a deal breaker. I guess I'll know soon enough, as we'll be submitting for approval toward the end of the month.

[marybowlus 17]

I've been told that the language for Aetna's policy changed and says "contemporaneous" not 2 years. I'm trusting my Bariatric gurus on this. Final weigh in before submitting to Aetna is on May 5th. I will keep you posted on approval outcome. Should know something one to two weeks after that!

[handymannynyc1 82]

Hey Marybowlus my last weigh in is in may. I just finished all the pre op stuff AETNA required. As long as your bmi is 40 + you should be good. Under 40 they want sleep apnea or blood pressure ect. Make sure your primary doctor writes the letter stating who important thus surgery is to your well being

[rwoods200 39]

My claim hasn't yet been approved, as I'm still in the beginning stages of this journey, but from what I can gather from both my surgeons office and Accolade (a health assistant group that is provided by my employer) I shouldn't have have any issues as I have high blood pressure, high cholesterol, diabetes and a severe thyroid issue. I think you'll be fine as long as your BMI didn't go under 35.

Rhonda

[marybowlus 17]

@@handymannynyc1 . . . Thanks for the info. I'm trying to be really good these last few days before my final weigh in prior to my paperwork being submitted to Aetna. I want this badly. I'm ready for this! I deserve this!

[SleevePerry 248]

I was approved!!!!! Surgery is June 9th!