Approval for Aetna with a BMI between 36 & 37

[Lenamarie301 43]

I have thought about the approval process for my gastric sleeve about 100 times. I have really just started the process. I went to my first seminar and I am starting to do my supervised diet visits. I don't have documented sleep apnea but I am going to have them check for it. I have hypertension (lower BP # is 98 or higher). The surgeon put me on a BP RX but I don't think it's the one aetna will approve for because it's not a 3 drugs in one. I am so scared I am wasting my time because I won't get approved.... Is anyone in a similar boat that could offer some advice? Thanks in advance

[KristenLe 5,980]

What are the requirements for coverage with your plan? Do you have to only have 1 comorbity with a BMI 35-40? If so - hypertension should count. Get your plan requirements in writing from Aetna.

[Lenamarie301 43]

It says something about me needing to have taken a blood pressure RX that is a combination drug (3 in1) and for it not to work. I have tried for over 10 years to keep the excess weight off with no success so I am praying things work out for me.

[saj8380 0]

Hey Ladies what was your outcome? I also have Aetna with no comorbities but I also had the gastric sleeve in 2011...I wanted to try and get the lap band if I could...after my weight loss surgery I had a few more surgery's, then birth control and steroids and Migraine meds came into play and I have been having a super hard time losing the extra weight

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[Lenamarie301 43]

What are the requirements for coverage with your plan? Do you have to only have 1 comorbity with a BMI 35-40? If so - hypertension should count. Get your plan requirements in writing from Aetna.

I am on my 3rd diet appointment. I have to go in November for class to learn how to properly eat and then last diet appointment in December. I have sleep apnea and high blood pressure. I am still scared about getting approved. I guess we will out in December. Praying for the best!

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[saj8380 0]

What are the requirements for coverage with your plan? Do you have to only have 1 comorbity with a BMI 35-40? If so - hypertension should count. Get your plan requirements in writing from Aetna.

I am on my 3rd diet appointment. I have to go in November for class to learn how to properly eat and then last diet appointment in December. I have sleep apnea and high blood pressure. I am still scared about getting approved. I guess we will out in December. Praying for the best!

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My plan requires BMI greater than 35 to have on ly one comobity but I don't have any

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[Lenamarie301 43]

Did you ask your primary Dr to get a sleep study test done? I didn't know I had sleep apnea until I took the test

What are the requirements for coverage with your plan? Do you have to only have 1 comorbity with a BMI 35-40? If so - hypertension should count. Get your plan requirements in writing from Aetna.

I am on my 3rd diet appointment. I have to go in November for class to learn how to properly eat and then last diet appointment in December. I have sleep apnea and high blood pressure. I am still scared about getting approved. I guess we will out in December. Praying for the best!

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My plan requires BMI greater than 35 to have on ly one comobity but I don't have any

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[moe_2175 33]

I also have Aetna and I had my initial consultation September 28. That's when the patient navigator told me that my plan requires 3 months diet/exercise supervision. My BMI is 38 and I have hypertension and pre-diabetic.

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[Lenamarie301 43]

My 1st visit with the office for my diet didn't count. So I will wind up doing 5 total. My last one is in December. I am wondering when they will submit for approval and when my liquid diet has to start

I also have Aetna and I had my initial consultation September 28. That's when the patient navigator told me that my plan requires 3 months diet/exercise supervision. My BMI is 38 and I have hypertension and pre-diabetic.


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[moe_2175 33]

@@Lenamarie301 I had attended the seminar and completed all the relevant ppwk and submitted prior to my first appointment a week later. They had all the insurance requirements ready for that meeting and was a little overwhelmed and excited at how fast it seems to go. December 29 is when my final appointment where I will fill out the consent paperwork and will submit for insurance thereafter. They told me for my insurance plan it averages four months from initial apt to surgery date so I'm looking at surgery for January. Two weeks prior to the surgery is when I have the pre-op apt and that's when they will start the liquid diet

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[Lenamarie301 43]

@@Lenamarie301 I had attended the seminar and completed all the relevant ppwk and submitted prior to my first appointment a week later. They had all the insurance requirements ready for that meeting and was a little overwhelmed and excited at how fast it seems to go. December 29 is when my final appointment where I will fill out the consent paperwork and will submit for insurance thereafter. They told me for my insurance plan it averages four months from initial apt to surgery date so I'm looking at surgery for January. Two weeks prior to the surgery is when I have the pre-op apt and that's when they will start the liquid diet

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Thank you! I am nervous about getting approved. My next appointment is a meeting along with others who are waiting for surgery and some post op people so we can get a little more insight. That is November 17th

[Lenamarie301 43]

My papers were either submitted today or will be in the morning I am done with my diet and all. I am just praying for the best. I gained 1lb more than I weighed at my appointment after my consultation. I am little worried

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[dyemond11 43]

I have BCBS AL and I was denied the first time I submitted all information. I had the option to appeal or do what they asked to the tee.

I had high blood pressure

My BMI was over 35 for at least 3 years

I was not a smoker

I was in a diet program the year prior from Jan- July, but I missed going to the dr. In feb. they denied me because I missed 1 month and the six months they required were not consecutive. It took a month to receive the denial. I had to start all over... 7 total visits to the dietitian with 30 days in between and 3 documented visits to the Dr. In reference to weight loss. My information was submitted around Nov 18th, my surgery date was 12/12/16. I got approved super fast the 2nd time. Don't rush it make sure u have every thing u need the first time so u don't have to start over.

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