I have a question

I was just reading Aetna's CB 157. I have Aetna EPO.  It states that you have to meet the following qualifications for surgery:

1.  Presence of severe obesity that has persisted for at least 5 years, defined as any of the following:

 

1. Body mass index (BMI)* exceeding 40; or
2. BMI* greater than 35 in conjunction with any of the following severe co-morbidities:
   1. Coronary heart disease; or
   2. Type 2 diabetes mellitus; or
   3. Clinically significant obstructive sleep apnea (i.e., patient meets the criteria for treatment of obstructive sleep apnea set forth in Aetna CPB 004 - Obstructive Sleep Apnea); or
   4. Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management);

2.  Completed Growth 3.  Member has attempted weight loss in the past without successful long-term weight reduction; 4.  Member must meet either criterion a (physician-supervised nutrition and exercise program) or criterion b (multidisciplinary surgical preparatory regimen): 5.  For members who have a history of severe psychiatric disturbance (schizophrenia, borderline personality disorder, suicidal ideation, severe depression) or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medications, a pre-operative psychological evaluation and clearance is necessary in order to exclude members who are unable to provide informed consent or who are unable to comply with the pre- and postoperative regimen. Note: The presence of depression due to obesity is not normally considered a contraindication to obesity surgery. My question is this:  I have not been MO for 5 years and I haven't had any of the co-morbidities.  I have been overweight all of my adult life.  In 2002, I weighed 232.  I lost some weight and got down to 200, but was unable to keep it off.  Now, I'm at 272.  I can loose weight but am unable to keep it off.   Does anybody know if they will deny me because of this? 

 

If your BMI fell below 40 at any time in the last 5 years they could use that to deny you....not necessarily the case, but possible.  All you can do is try.  At what point did you drop below?  How many years ago?  You might only have to wait a few months if you dropped below 40 BMI like...4 years ago.

I'm 5'5".  I was 200 (BMI 33.2) and 232 (38.6) in 2002.  To be MO for my height I would have to be  241 lbs, which I have weighed for the last 3 years.  I'm getting frustrated, because I think they just changed their policy this September and I've been looking into this surgery since 2003!

Yours must have been opposite from mine.  BCBS of Alabama used to require 5 years but in August changed that to 3 years.  I've been morbidly obese for several years, so it didn't matter to me, but I bet it helped some people.  I also kept checking my policy online every month or so just to make sure they didn't sneak something new in there. 

I sure hope they approve me!  Both my parents died recently and I don't want to die they did.