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Has anyone been denied by aetna my Bmi is 41 by I don't have any medical issues met all there requirements

Trina47

By Trina47, in Insurance & Financing

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Anna Nim    196

Anna Nim
Posted

I have Aetna TRS, my BMI is a 41. That is morbid obese, they will cover.

I did 4 Nut vists, a psy eval (the guy gave me bubble sheets to fill out, after a short convo) and a EKG.

I got a doctor that I had JUST met to write me a letter. It had to have my 'history'.

Smart me, brought a letter for the Dr. that literally copied what Aetna said it had to have, plus my history.

That way when she walked out of the room, she would remember what I talked to her about. I also brought my healthy blood work (from the summer OBGYN, whom I also had just met) and my knee xrays, so she was coming of a place of information. I told her that she could just write "Patient reports...."

My Baratric Doctor said the letter was great.

They submitted and said that the surgery as end of Nov and I got approval in like a week-maybe less!

My surgery is the 14th of Dec and I am doing the pre-op.

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Aggiemae    739

Aggiemae
Posted

Have you Checked to see if the policy you have covers WLS?

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Mindy78    372

Mindy78
Posted

They said over 40 w/o a comobility mine was around 45 w other issues

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jaynamy3    122

jaynamy3
Posted (edited)

My BMI was 42 when my surgeons office submitted my info to Aetna a few weeks ago. Got a call from the office stating I was denied for not having a high enough BMI and not having enough wrong with me. I only have high blood pressure and GERD ( I am thankful that is ALLLL I have wrong with me). Also stated that my blood pressure is "under control" with 2 medications so I don't fit the 3 medication scenario they wanted when you are under control.

GET THIS...... My BMI was apparently submitted as 39.7 through the surgeons office. They actually have it as 42 (I keep copies of everything so I have proof) as well as my physician's office where I did 3 consecutive months of multi disciplinary surgical prep (actually 4 months now). My NUT also submitted my info with all her weights she took which was over 40.

I called the surgeons office today to ask where Aetna got that BMI from and the lady said she didn't know. I had her look up my very first visit while I was on the phone with her and she said " Oh it is 42"!??? and apologized. This is the 2nd lady I have had working on my case since I stated this journey on July 1st. I am just at a loss. I pray this time they get the right info to approve me. I may have to put my big girl panties on and call Aetna myself. I think I am actually getting upset with the surgeons office. GRRRR

Edited by jaynamy3
Arielle reacted to this

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Trina47    0

Trina47
Posted

My BMI was 42 when my surgeons office submitted my info to Aetna a few weeks ago. Got a call from the office stating I was denied for not having a high enough BMI and not having enough wrong with me. I only have high blood pressure and GERD ( I am thankful that is ALLLL I have wrong with me). Also stated that my blood pressure is "under control" with 2 medications so I don't fit the 3 medication scenario they wanted when you are under control.

GET THIS...... My BMI was apparently submitted as 39.7 through the surgeons office. They actually have it as 42 (I keep copies of everything so I have proof) as well as my physician's office where I did 3 consecutive months of multi disciplinary surgical prep (actually 4 months now). My NUT also submitted my info with all her weights she took which was over 40.

I called the surgeons office today to ask where Aetna got that BMI from and the lady said she didn't know. I had her look up my very first visit while I was on the phone with her and she said " Oh it is 42"!??? and apologized. This is the 2nd lady I have had working on my case since I stated this journey on July 1st. I am just at a loss. I pray this time they get the right info to approve me. I may have to put my big girl panties on and call Aetna myself. I think I am actually getting upset with the surgeons office. GRRRR

You would not among, the freaking back and forth is driving me crazy so today they said my surgon needs to do a peer to peer with Aetna on the phone explain why I need the surgery. . Well at the time I didn't tell my surgon that I have Pantai fasciitia in my foot and on FMLA on my job and lit duty and the reason I have it is that I'm obesity. So I'm going to give them this information and see what happens

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Trina47    0

Trina47
Posted

My BMI was 42 when my surgeons office submitted my info to Aetna a few weeks ago. Got a call from the office stating I was denied for not having a high enough BMI and not having enough wrong with me. I only have high blood pressure and GERD ( I am thankful that is ALLLL I have wrong with me). Also stated that my blood pressure is "under control" with 2 medications so I don't fit the 3 medication scenario they wanted when you are under control.

GET THIS...... My BMI was apparently submitted as 39.7 through the surgeons office. They actually have it as 42 (I keep copies of everything so I have proof) as well as my physician's office where I did 3 consecutive months of multi disciplinary surgical prep (actually 4 months now). My NUT also submitted my info with all her weights she took which was over 40.

I called the surgeons office today to ask where Aetna got that BMI from and the lady said she didn't know. I had her look up my very first visit while I was on the phone with her and she said " Oh it is 42"!??? and apologized. This is the 2nd lady I have had working on my case since I stated this journey on July 1st. I am just at a loss. I pray this time they get the right info to approve me. I may have to put my big girl panties on and call Aetna myself. I think I am actually getting upset with the surgeons office. GRRRR

You would not among, the freaking back and forth is driving me crazy so today they said my surgon needs to do a peer to peer with Aetna on the phone explain why I need the surgery. . Well at the time I didn't tell my surgon that I have Pantai fasciitia in my foot and on FMLA on my job and lit duty and the reason I have it is that I'm obesity. So I'm going to give them this information and see what happens

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Sorry imagine

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jaynamy3    122

jaynamy3
Posted

Hopefully a peer to peer works for you. It seems to me at least with MY problem it's with the surgeons office I chose and not Aetna. I spoke to my case worker at Aetna today who indicated my BMI is under Bc the surgeons office has me an inch taller than my family physician, gynecologist, and nutritionist that kept weights and my height as well. So it's the surgeons office who screwed up on my behalf. I left the office a message to call me and a short sweet to the point message of you have my height at 5'6" which is wrong. I was nice but still makes me angry.

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Cocoon2Butterfly    64

Cocoon2Butterfly
Posted

My BMI was 42 when my surgeons office submitted my info to Aetna a few weeks ago. Got a call from the office stating I was denied for not having a high enough BMI and not having enough wrong with me. I only have high blood pressure and GERD ( I am thankful that is ALLLL I have wrong with me). Also stated that my blood pressure is "under control" with 2 medications so I don't fit the 3 medication scenario they wanted when you are under control.

GET THIS...... My BMI was apparently submitted as 39.7 through the surgeons office. They actually have it as 42 (I keep copies of everything so I have proof) as well as my physician's office where I did 3 consecutive months of multi disciplinary surgical prep (actually 4 months now). My NUT also submitted my info with all her weights she took which was over 40.

I called the surgeons office today to ask where Aetna got that BMI from and the lady said she didn't know. I had her look up my very first visit while I was on the phone with her and she said " Oh it is 42"!??? and apologized. This is the 2nd lady I have had working on my case since I stated this journey on July 1st. I am just at a loss. I pray this time they get the right info to approve me. I may have to put my big girl panties on and call Aetna myself. I think I am actually getting upset with the surgeons office. GRRRR

I called the insurance myself. Come to find there insurance approval is with another company. I received 2 denials. I started making calls. Their requirements are different than what have on my policy. FIGHT IT

Cocoon to Butterfly

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Cocoon2Butterfly    64

Cocoon2Butterfly
Posted

Don't get upset with the surgeon before you compare your policy and the insurance approval department. Stay strong.

Cocoon to Butterfly

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jaynamy3    122

jaynamy3
Posted (edited)

I'm excited! I finally got was approved after being denied. Found out today but still haven't heard from the scheduling girls. Still don't know when my surgery will be... just that it was approved! YAY

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Edited by jaynamy3

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Cocoon2Butterfly    64

Cocoon2Butterfly
Posted

I'm excited! I finally got was approved after being denied. Found out today but still haven't heard from the scheduling girls. Still don't know when my surgery will be... just that it was approved! YAY

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Congratulations

Cocoon to Butterfly

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olamae    16

olamae
Posted

Please keep me posted on this thread. I started with another insurance and a bmi of 42 and now a 41.7 I am afraid to lose too much weight because I have no comorbids. Do they go by starting weight?

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