Aetna and Weight History

Kind of related to my other post...  maybe some experts here can help.

I posted this last week on the main forum.

Aetna requires  "Presence of severe obesity (40+ BMI) that has persisted for at least 5 years".  I have 14 years of history of MO/SMO, however, I am missing a weight from 2005.  October 2004 287 lbs (49 BMI) - February 2006 307 lbs (52 BMI).  Lowest in all 14 years is 271 lbs (46 BMI) How likely is this gap to affect my approval?  Thanks in advance!!!

It is pretty likely they will deny it based on that and you will have to appeal. you will get it through, but they have denied many of our patients for that one reason alone, one single missing weight in the 5 year history. Include more than just the 5 years of weights as well as an explanation for the missing weight, like you did not have insurance to see a doc, etc. Are you absolutely sure you cannot get a weight from somewhere, on OB, hospital, allergist, weigh****chers, school, anywhere? It does not have to be a primary doc. One of my patients used her high school records! Documentation is documentation!  Hopefully the one at your surgeons office will recognize this missing info and help you head off the denial. Appealing a stupid decision like that is a waste of everyones time, but afterall, they are employed to deny you, aren't they? It's pretty unlikely you were 300 pounds than 150 then 300 again right? By the way--I'm a nurse for a bariatric surgeon and this is 90% of  my job--insurance. You'll get there, just a bump in the road! Bonnie 264/155

Thank you! I don't think I have any weights anywhere else.  I will keep looking.  Thanks!!!

Hi Tiffany-- I'm in a similar boat right now-- although I've been obese all my life (I'm 37) I was one of those people who only went to the doctor when I was sick-- consequently I'm missing 3 years of records.  I misunderstood the preapproval program I underwent at Barix-- thought you had to have a BMI >40 OR be able to prove 5+ yrs of obesity, not both.  Hope it works out for both of us-- like the other reply said, it's unlikely in those missing records that I was 300 lb, then 120, then 300 again!

Let me know how you make out!  I will do the same!

Sometimes they'll approve dated pictures, weights from driver's lic (if issued that yr), applications for life insurance usually require it, passport pics, pre-employement physical. I knew os someone using her wedding picture (which wasn't dated on the pic/back of pic) along with her wedding anouncement or marriage certificate. Be creative. You might even be able to get your doc to write a letter that, given your BMI before the gap in your records until the next record, it would be impossible to lose the wt to go below 40BMI and regain it all in time for the next doctor's appt/record. Finally, I would take the wording of the policy/requirement at FACE VALUE. In legal terms (and maybe Gary can chime in here), it doesn't say the "last 5 yrs" or even 5 consequative years. Like, if you were MO for 5 years and then dieted (like we all do) and went below 40 BMI, and then eventually regained it all (like we all do) and are currently M.O. again-- doesn't that meet the requirement? I think I'll post this as a separate topic..... Good luck, Kahlua