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Aetna questions



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After starting the process almost 3 years ago and then bailing due to husband's sudden health issue I find myself here again.

I'm back to considering the VSG. My insurance covers it (Aetna) but I'm reading stories of people being denied because their weight history has an occurrence of a BMI under 35 in the past 24 months That would be August 2018 for me

After putting off surgery my Dr. put me on Vyvanse. It worked for a while and at one weigh in my BMI reported at 34.8. Problem is, I self-reported my height all of these years and I'm actually an inch shorter than I thought I was, I guess that's Water under the bridge. If I had let the Dr. measure me I never would have been under 35 BMI. I have sleep apnea and use a CPAP.

Has anyone been denied because of this? I mean, the weight came right back at the next 3 month checkup. I stopped the meds and am now at my highest weight.

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My BMI was under 30 but I had the comorbidity of sleep apnea and I was approved. Of course it wasn't Aetna.

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1 minute ago, GradyCat said:

My BMI was under 30 but I had the comorbidity of sleep apnea and I was approved. Of course it wasn't Aetna.

Thanks! Aetna clearly states 35 and over BMI but at only one time during the year would my weight have been under at a 34.8. The test or the reported weights that year are over 35 BMI. Of course I self reported as an inch taller than I actually am. I guess I seem taller to myself :)

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Same situation here. My authorization was sent to Aetna today so we’ll see. Fingers crossed for an approval.

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Best of luck, keep me posted. If everything works out for me I’m looking at a May surgery.

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I’ll keep you posted

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On 2/4/2020 at 5:24 PM, 3sonsitk said:

I’ll keep you posted

I received the call that Aetna approved me. Surgery scheduled for 2/27. With that said, my BMI was less than 35 for the pst 2 years with no comorbidities until my PCP ordered a sleep study that shows I have mild sleep apnea.

Edited by 3sonsitk

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Wow, that was a super fast turnaround and great news for you! Congratulations! That alleviates my fears a little.

there’s a woman in another bariatric group that I’m in that just had Aetna deny her claim because they wanted five years of her weight history instead of two. Isn’t it strange? I totally think it’s just up to the whim of the person reviewing it.

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