Aetna POS II question
My surgeon submitted all my paperwork a couple weeks ago for WLS and I received the denial letter a couple days ago. The denial was based upon lack of evidence of morbid obesity (40+ BMI) over the last 5 years and the need for a 3-month pre-op multi-disciplinary plan. The second reason I can address fairly easily through my doctor - I start next week. My question is on the first point...when I went to see my surgeon a month ago that was the first time, in I don't know how long, someone actually measured my height. I was 2 inches shorter than I thought (not quit sure where I came up with 5' 6"...my husband is always quick to tell me I have never been 5' 6"). Anway, anytime I went in to see my PCP the nurse simply would ask my height and I always said 5'6". How do I need to address the fact that I have been reporting my height wrong over the past 5 years? The height differential affects my being the 40+ BMI I need. Thank you for any information/guidance you can provide.
That's a tricky situation! Those 2 inches actually make a difference in meeting the 40 BMI requirement? You know what I would do? I don't know if this is even possible, but I wonder if you can just submit your weight only for the last 5 years...and then submit your height only from your last visit. I don't think they would care because no one expects height to change...to calculate your BMI for the last 5 years, they only need your weight for the last five years and your height. Who cares whether the height is included in each 5 year record of weight? They should just need your height once...doesn't matter when. That's just my thoughts...I don't know though, they may be sticklers. I think it's worth a try though... The only problem is that your height is probably a part of the overall medical record for each of those visits. I'm not exactly sure how you could NOT submit it. But I'd look into that. If that's not an option, then I don't know what to tell you...some insurance companies allow under 40 BMI if there are comorbidities. Good luck!