Aetna and wording....

I know that I am going to get caught up in the 5 year history problem with Aetna. I did NOT go to a doctor or did I do any supervised diets during the years of 2003 and 2004. I did not have insurance I was not sick. I did go to the school clinic in 2002 and have a record of my height/weight. I feel this qualifies for the (quoted from Aetna's website)

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:

Since it shows that I was 320 lbs in 2002....therefore I have been MO for 5 years. I am also working at getting some record from as far back at 1993 that will show that I have been heavy, but I dont remember how much I was. Anyways, on this wording in their bulletin, I would say that my record from 2002 would meet this requirement. What do you all say??? Any experience with Aetna and this restriction? Thanks Diana

Guess no one has any ideas or thoughts?

I wish I had an answer for you.  I read this part of the OH site for any glimpse of information about Aetna.  That is why I read your post.  I too did not keep up with "going to the doctor" for being over weight.  I did go to the doctor for various things (I guess I am glad they weigh you when you go to the doctor...i usually complain but do it...now it will work out that I did hahaha).  Anyway, I think that you didn't get to a 320 pounds weight overnight and you definitely wouldn't have lost that much weight right after that.  So...with that being said, I would love to hear their excuse for you NOT proving your 5 year weight history being that that was exactly 5 years ago.  You would have had to start gaining that well before 5 years ago and you obviously have kept it on, that is why you are seeking weight loss surgery.  Insurance companies kill me.  Do they think we make this decision lightly?  We are going for a lifetime of changes, I think we deserve to have our insurance cover us for our own health and wellbeing. Please keep me informed on anything you hear.  I am a basket case.  I start the "3 month" multi-disciplinary diet at the Atlanta Wellness Center in August.  I am having trouble with the either/or of the diet requirement.  They say you either have to have a 6 month doctor supervised diet OR a 3 month multi-disciplinary diet.  Which one is it?  I am praying that they will accept the 3month...but we will see.  If you know anything about that part, please lt me know. Good luck with everything.  We both are going to need a lot of prayers since we have Aetna....yuck Cyndi

I did the 6 month one, and I am hoping that is not why they denied me. I haven't gotten the letter yet. Have you read the whole Aetna bulletin on the surgery?

I did not know you had already been denied and just waiting for your letter.  Please let me know why when you get it.  As far as the Aetna bulletin, I'm not sure what you are talking about.  I guess I haven't.  Send me a link to it. Thanks, Cyndi

I have Aetna and am trying for the three month program.  I am worried because I have only been a BMI of over 40 for the last two years and over 35 but with none of listed co-morbidities.  My approval request went in week last so now I am just waiting to hear what they say.  I have heard you have to meet all the criteria in the health bulletin to qualify as far as diet, Nutritionist and behavior modification.  I will try to let you know.  I don't know how these boards work at this point it i**** and miss.  LOL.