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!

Kerriedc. Did they have to submit a weight history? I am a bit worried even though my bmi is over 40 now that was not always the case.

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I had the same concern. My BMI in previous years was 38 or 39. I'm not sure what it was that got me the approval, to be honest. I don't have any of the co-morbidities, but I was pre-hypertensive and pre-diabetic, with a familial history of such conditions, so perhaps Aetna thought it wise to approve surgery as a preventative measure? In any case, good luck! I hope it works out for you, too!

And I believe they did submit a weight history but I think that Aetna was looking for a history of persistent obesity, not necessarily a consistent BMI number of 40 or above.

@@kjsweigart I saw my insurance coordinator yesterday and asked her how she got my surgery approved, with no comorbidities and a BMI of under 40 in previous years. She specifically said that Aetna no longer needs two years of a 40 BMI. If you have a BMI of 40 now, you should be good to go.

@kerriedc. So she did not submit any previous weight history ?

That's good to hear. I'm going to my last weigh in as we speak and all my post op stuff is done. Let see what they say.

@@kjsweigart No, she did not, but I'm sure the surgeon noted a history of obesity in my chart when I had my initial visit with her.

I'm Jealous! LOL! I have no idea where I am in the approval process exceptto know I need to pay my deductible before my endo next month.

That is great news. I have a letter from my pcp as well saying I have battled with obesity my entire life and that they recommend the surgery. I also wrote a letter from myself. Did you do that? Thanks for making my day. I have been so worried about my history at 38 to 39 bmi.

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@@kjsweigart I had a letter ready to go, but the insurance gal said it wasn't needed. I also had a letter of necessity from my PCP, and not sure if she used that or not. She said it was also not needed. Just the surgeon's and nutritionist's notes, from what I understand.

ALL OF MY INFO WAS SUBMITTED ON MAY 7TH AND I'M STILL WAITING TO HEAR WHETHER OR NOT APPROVED. THIS IS DEFINITELY THE HARDEST PART OF THE PROCESS (FOR ME). I HAVE CALLED EVERY DAY AND THANK GOODNESS I GET SOMEONE DIFFERENT EACH TIME BUT I JUST KEEP HOPING THAT WHEN I CALL SOMEONE WILL SAY "OH YES, YOU HAVE BEEN APPROVED!" I'M TRYING TO BE PATIENT BUT THIS IS ALL CONSUMING!

@@marybowlus I in NY and the people at work that got the surgery done said it took a week to two weeks before approval.

@@kjsweigart my cardiologist letter was not written the way the insurance likes so I have to get another one that says" as a cardiologist It is in the best interest for this" lol all these hoops they want me to go through.

I have Aetna, I had to do an upper GI, blood work, an EKG, a letter from my PCP recommending the surgery, a psych eval and 2 years of pcp notes from visits with at least 6 months of weight loss attempts with 3 of those being consecutive months.

Aetna stated it takes them 2 weeks when all documentation is provided to approve.

Thanks to my surgeon's office it took me 2 and a half months to get approved. They did not follow what Aetna asked for and dropped the ball in a major way!