Experiences with Aetna PEBB

I have just recently acquired insurance with Aetna PEBB coverage. I looked up the requirements for qualifying for gastric bypass and now I'm afraid that I won't qualify. You either have to have High Cholesterol, Diabetes, High Blood Pressure or Sleep Apnea. I'm more than positive that I have Sleep Apnea, just not documented by a doctor. I am 5'6" and 333lbs. I have had Gestational Diabetes 2X's and luckily it went away both times. So basically I am asking people with my similar situation what can I do. I have a Dr's appt on Monday to start the process of blood work....hoping I have High Cholesterol so that it will help me qualify. My insurance won't even let me see the Bariatric Surgeon that I choose off of their website until I get a case manager to approve me. HELP!!!!

I also have Aetna PEBB through the State of Washington.  I would highly suggest you go to the Aetna website and take their bariatric surgery questionaire.  They will contact you after that.  You will be assigned a case manager who will work with you and get you through the process.  I haven't had surgery yet, but that is where I started, unfortunately (or fortunately) I have 4 co-morbidities. Hope this helps some!  Good Luck to you. Debbie

Hi, I have Uniform PEBB but they have the same requirements as Aetna as far as BMI and comorbidities go.  I qualified with cholesterol of 211. I also have sleep apnea but they didn't learn that until after they had assigned me a case manager.

I was approved into the pre-surg bariatric program in Jan 08.  I had to lose 5% of a recent dr verified weight.  I met that requirement in March 08.  On April 15 I went to the OWLS seminar, had my medical consults on May 13-14 and surgical consult in June 4.  They submitted to my insur on June 9.  Unfortunately due to a glitch with the fax machine Uniform didn't receive my paperwork till June 16.  Then due to a typo I was denied on June 20. I had the dr office correct the typo and resubmit the same day.  Now I'm waiting to hear back again. Hopefully I'll hear by tomorrow but I might have to wait till Fri, June 27.

Good luck, be patient, and make sure to stay on top of your dr/surg office and your case manager!  Alicia

Thanks for the encouragment. I will be going to the Dr's tomorrow so we'll see what the test results say. I refuse to give up. It's just all so frustrating.

I don't have aetna atm, but I did have them when I was diagnosed with sleep apnea.  I would get evaluated for that asap. Ask your pcp for a referal to the pulmonologist(sic). I think that at your bmi if you think you might have it you will get diagnosed with it.

I went to my pcp on Monday to have some blood tests done. My doc didn't think that I would be diagnosed with sleep apnea. We'll see. They called back the next day to let me know that I am pre-diabetic and have high cholesterol. Thank goodness. Now onto the next step. The lady giving me my diagnoses on the phone couldn't understand why I was so happy with bad results. I of coarse had to explain.