DENIED by Aetna

WDW Luver · August 13, 2009

Well I finally got a decision and it isn't good. I was denied because of my 2 year history. No co-morbidities with a BMI between 35-40.

At least none of their co-morbidities. The fact that I am disabled because of severe foot issues aggravated by the excessive weight means nothing.

We will appeal. I will get more letters from my doctors and my podiatrist. Until then I will cry.

cc369369 · August 26, 2009

What was your 2 year history that caused them to deny your surgery?

amlus · August 26, 2009

Yep...I am in the same boat except denied by Blue Cross. I have a 12 month pre-existing clause on my insurance so they denied me because of this. In my fifth month of having this policy now. Also, at they also want a three-year BMI of over 40 and I have been 38-39 and over 41 for just the last year. No major comorbidities......So, I can go self-pay or wait 1-2years MORE. It really stinks. I feel your pain...:thumbdown:

WDW Luver · August 27, 2009

What was your 2 year history that caused them to deny your surgery?

NOTHING! That is the problem. I have had a BMI over 35 but no comorbidities. Without them I can't qualify. I am going for a sleep apnea test next week.

ParrotheadCathy · August 27, 2009

WDW, most insurance policies (not all) require a BMI of 40 OR they will accept a BMI of 35 with TWO of a pre-set lislt of comorbidities (usually, high blood pressure, sleep apnea, Type 2 diabetes, sometimes high cholesterol).

I know that a friend's insurance accepted a BMI of 37 BUT you had to have documentation to prove that your BMI has been at least 37 for 3 years.

You MIGHT be able to eventually win approval with your foot problems, but I wouldn't hold my breath on it. Insurance companies really don't want to spend the money even if spending it now would save them money down the line.