Which Number Will AETNA Look At?

[Jameskc 0]

Will they look at my bmi before going on the 6 month diet or the bmi once I have completed the 6 month diet? It matters because I am borderline. I could, quite possibly, diet myself to a bmi which is under 35. Any thoughts?

[lafevretj 0]

My insurance company went by the BMI before the 6 month physician supervised diet. I was very worried about this because I started with a BMI of 40.

[kdlee 0]

Most insurance companies look at the BMI before the diet, or so my physician's office told me. My insurance does not require the 6 month diet though. My question is, do you have any co-morbidities to go along with your BMI? Most insurance companies require you to have co-morbidities (like diabetes, high blood pressure, etc) to go along with a BMI between 35-40 before they will cover the surgery. The best thing to do is to call Aetna or get on their website and look for the specific policy. I have Anthem BC/BS and found the policy on their website.

[Froggi 4]

Almost all insurances use the before BMI before the 6 month. Mine is but my BMI is way high but either way you should be fine. I wish you luck.

[Flowerpurr 0]

Ok here is the low down with Aetna. I have them as well and I to was worried about my bmi going below 40 because I have no co-morbities. If you lose weight on the six month diet and go below 35bmi they will not pay for surgery! Aetna sucks and they are trying to get out of paying for anything they can. So becareful on how much you lose plus you need two co-morbities with your bmi being so low. I hope this helps.

[Jameskc 0]

Ok here is the low down with Aetna. I have them as well and I to was worried about my bmi going below 40 because I have no co-morbities. If you lose weight on the six month diet and go below 35bmi they will not pay for surgery! Aetna sucks and they are trying to get out of paying for anything they can. So becareful on how much you lose plus you need two co-morbities with your bmi being so low. I hope this helps.

This is what worries me. I am a 35 bmi with several comorbids and, currently, that qualifies for the band. But if I go on another diet and lose, say 10-15 pounds, I will then be under a 35 bmi.

The surgeons office told me that going on the diet doesn't mean I have to succeed at the diet. They told me to jump through the hoops, report in to the doctor each month for weighing - but to make sure I didn't lose any weight.

Does this sound like the best plan?

Edited May 30, 2008 by Jameskc

[kdlee 0]

The surgeons office told me that going on the diet doesn't mean I have to succeed at the diet. They told me to jump through the hoops, report in to the doctor each month for weighing - but to make sure I didn't lose any weight.

Does this sound like the best plan?

If you want insurance to pay, it sound like the only plan. It really is just all about jumping through the hoops. Good luck to you and I hope it works out well.

[Flowerpurr 0]

This is what worries me. I am a 35 bmi with several comorbids and, currently, that qualifies for the band. But if I go on another diet and lose, say 10-15 pounds, I will then be under a 35 bmi.

The surgeons office told me that going on the diet doesn't mean I have to succeed at the diet. They told me to jump through the hoops, report in to the doctor each month for weighing - but to make sure I didn't lose any weight.

Does this sound like the best plan?

Yes that is the best plan I think. Right now I am trying to tred Water to see if Aetna will approve me on a three month diet instead of a six. So I am trying not to lose another pound so I can stay above 40. See I have nothing wrong with me thank gawd and I would like to keep it that way. I would play games with Aetna just like they play them with us!

[efan82 1]

I have Aetna and my plan only required a 3 mos. diet plan. I was not suppose to go below 40 while on my diet. I gained on the diet. The doctor did not care. He wanted me to get it paid for.