I have just started seriously considering lapband surgery. So, I have checked my insurance (Aetna) and have found that I have coverage, I've reviewed their documents and meet the qualifications (BMI>35 + comorbidity). I don't mind doing the 3-6 month diet. Its a drop in the bucket compared to what I've already done before. The only sticking point I see is that my BMI has not been consistently over 35 for the past two years because I have dieted and then gained back. But, I can show 5+ years of going up and down and around 35 so I'm hoping that will suffice (probably will have to fight for it). The high BP has been persistent for 10+ years and not very well controlled w/medication so since Aetna only requires one comorbidity, it looks like I've got this one covered (plus recent diagnoses of high cholesterol).

OK, so I made an appt w/my PCP to discuss weight and possible lapband surgery on 1/6. She is great and I trust will give me a great referal to a bariatric surgeon. I've done a little research myself and found one that is considered the best in my area so also scheduled to attend a seminar the same week (1/11).

I'm just wondering if there is anything I can do in the meantime to start getting my info together. Specifically, since I'm worried that my weight/BMI history could be a problem, I'd like to start collecting that info. My former PCP and ob/gyn would have that info. Sooooo, do I ask that they send that to me or my new PCP or both? I would love to see it myself because I don't really recall what weights they will have. And, I'm also wondering that when we send weight history to Aetna, does my doctor then summarize the info that my other doctors have sent to her or does it have to come directly from those other doctors. If it goes to my new PCP first, is it OK to then have her only send the highest weight from each year? For example, I know at least two years out of the last five, I started out the year w/a BMI of 34 and ended w/a BMI of 36. I hate that I have to worry about just a few pounds here and there. Seems so silly in the whole scheme of things...

I would ask them if they would give it to me and then I would take it to my current doctor. If they are local you could try to arrange to pick the records up. I've done that with no problems but I think it really depends on the doctor. DH previous doctor would not release it to him. And one doctor tried to refuse releasing the records to anyone, then said that DH would have to pay them before they could release them...this also happened to my mom in PA once too. We fought and were finally able to get the records handed over. Not saying it will happen to you, just letting you know that some doctors can be a pain in the neck about this.

I would gather the weights yourself and then only present the weights where your BMI is above 35. You don't have to turn in every single weight so just leave out the ones that are too low. Also, Aetna does consider elevated BP a co-morbidity but usually only if it is "uncontrolled despite 2 medications" They do not accept high cholesterol. I would recommend having a sleep study done to see if you have sleep apnea since they do accept that diagnosis if it is severe enough.

Good Luck!

Kathy

I went to my doctor and asked to review my file and wrote down all the information in regards to weight, bp, and dates. I thin gave them the information a long with the letter they needed to send to the doctor. I also sent letters to the other doctors requesting the back dates on stuff but they no longer had my file since it was more than 7 years since I saw them. I put that in my letter and had no problems. My wife had problems with here pcp with hippa even though he was in charge so we just went to here OBGYN and got the same stuff with the letterfrom him and see was approved asap. If you would like I can forward you a copy of the letter that we used.

Chris

I would gather the weights yourself and then only present the weights where your BMI is above 35. You don't have to turn in every single weight so just leave out the ones that are too low. Also, Aetna does consider elevated BP a co-morbidity but usually only if it is "uncontrolled despite 2 medications" They do not accept high cholesterol. I would recommend having a sleep study done to see if you have sleep apnea since they do accept that diagnosis if it is severe enough.

Good Luck!

Kathy

Thanks! This is great advice. On the high bp, are they looking for you to take two medications at the same time or just have tried two medications without adequate results. I am actually on my 3rd medication for high bp and it is still not well controlled. I was on aldomet/methyldopa when TTC and PG because that's safe for pregnancy, but it only brought down my bp a little. My bp remained high, but not as high. Then, I tried aldomet which worked, but made me too tired all the time and made me gain weight. Now, I'm on lisiniprol (sp?), last visit to my doctor we doubled the dose because even though it brought my bp down, it was still high. But, what I haven't tried is two meds at the same time. Is this what aetna is looking for? I know some docs will prescribe a diuretic w/your bp med if the bp med alone is not working.

I went to my doctor and asked to review my file and wrote down all the information in regards to weight, bp, and dates. I thin gave them the information a long with the letter they needed to send to the doctor. I also sent letters to the other doctors requesting the back dates on stuff but they no longer had my file since it was more than 7 years since I saw them. I put that in my letter and had no problems. My wife had problems with here pcp with hippa even though he was in charge so we just went to here OBGYN and got the same stuff with the letterfrom him and see was approved asap. If you would like I can forward you a copy of the letter that we used.

Chris

Thanks for offering to send me the letter. I have contacted two of my doctors now and haven't run into any problems w/the process so far. One of my docs, just had a form to fill out on his site. The other I just called and she said I could come in to fill out their form or fax in a signed request. So, looks like getting the info is pretty easy. And, I'm having it all sent to myself just so I know what it is and then we can just send the best weights to insurance. Who would've ever thought my 'best' weights would be the highest ones. Or, that I wish I could be just one inch shorter. LOL

I would ask them if they would give it to me and then I would take it to my current doctor. If they are local you could try to arrange to pick the records up. I've done that with no problems but I think it really depends on the doctor. DH previous doctor would not release it to him. And one doctor tried to refuse releasing the records to anyone, then said that DH would have to pay them before they could release them...this also happened to my mom in PA once too. We fought and were finally able to get the records handed over. Not saying it will happen to you, just letting you know that some doctors can be a pain in the neck about this.

I noticed for one of my docs, the form said I might be charged for the copy service if you are asking the information to be released to yourself (as the patient), but its free to send directly to another doctor. I don't care, though. I want to see it for myself (as you recommended). Even if it costs me, then at least I have it for my own files and so if/when I'm turned down by my insurance, I have everything for the appeals process or to re-apply later.