Aetna & the 5 yrs of documented weights....

I just want you all to know that I was just approved by Aetna WITHOUT 5 years of documented weights. I technically only had a charted weight for 2007 however, I could have easily gone back to the doctor this month for 2008. I created my own 5 yr weight history on paper and submitted it. A copy of what was submitted is below. I wish you all luck in your approvals. I just wanted to share this here because I spent many hours reading posts here looking for hope that I had a chance of being approved without documented weights. Now maybe my story can be helpful to someone else.

Jenn

5 YEAR WEIGHT HISTORY

 

 

• 2008-  325lbs.
• 2007-  320-330lbs
• 2006-  315-325lbs
• 2005-  310-320lbs
• 2004-  290-310lbs

To Whom It May Concern at Aetna :

 

The purpose of this letter and the attached documentation is to back up the fact that I’ve met your criteria of severe obesity for 5 years. I have medically documented weights for 2008, and 2007. I was not under the care of a PCP for 2006, 2005 and 2004, however, I did see my psychiatrist during all of the years in question. I’ve included a letter from my Psychiatrist verifying that he did treat me during the above years and that I was clearly severely obese during the years he treated me. I have also included a letter from my dentist who treated me during the above years as well.

 

Sincerely,

 

JW

As a nurse for a bariatric surgeon, 90% of my job is pre-d's for surgery. I can honestly tell you that it was the letters from the docs that documented your obesity, not your handwritten weight history that got your approval.  I am not knocking you in anyway, I am wicked happy for you. I just wanted to make it clear for others who might read it and think that if they write down their weight history, that it will fly, when it really will not. Welcome to the losing side! Bonnie 264/155

You are probably right.  Jenn

Regardless, Congratulations!

Bonnie, This is my idea for my weight history.  I have a 16 month gap, which equals no weight recorded in 2005.  This is part of a letter I will include when I submit to Aetna, along with some pictures and a printout of a message board post from 3fatchicks.com. "One of the requirements for surgery is the “presence of severe obesity that has persisted for at least 5 years...” as indicated by a BMI greater than 40.  I have included the past 14 years of medical records showing my consistent and increasing morbid and super-morbid obesity. I am aware that I do not have an official weight recorded in my medical file in 2005.  I did not visit my doctor at all that year.  However, I remained morbidly obese and even gained 20 lbs in the time between the October 2004 visit and the February 2006 visit. In an attempt to prove that my morbid obesity still existed in 2005, I have enclosed pictures that were taken in Jacksonville, Florida, in February 2005, when my family and I went to Superbowl XXXIX.  I was approximately 290 lbs (BMI 49.8). I am also including a message board post from 3fatchicks.com that I wrote in June 2005.  From the printout, you can clearly see that I’m logged in as the user xxxxxx.  The post details my first name, reflects my age at the time and the fact that I have a son and fiancé.  I wrote about how I hit my highest weight ever at the end of 2004 - 290 lbs (BMI 49.8) - and that in January 2005 I started exercising using The FIRM system and lost 10 lbs but stalled.  In June 2005 I was approximately 280 lbs (BMI 48.1). By February 2006, I was up to 307 lbs (BMI 52.7) when I weighed in at my doctor’s office.  I hope you will find that these two pieces of evidence prove that my morbid obesity was present in 2005." I also will ask my PCP to include a statement that she believes I remained MO during 2005, even though she didn't treat me.  Do you think this will work?

Hey Tiffany! Although that is a great idea, it's way too in-depth.  Aetna will never actually read all of it. You also do not need 14 years worth of medical records. I have seen them deny just because too much paperwork was submitted and they do not want to sift through it all. Very simply, include one weight/office note per year, do not send your entire medical history.  So many patients bring usless stuff, like mammograms, pap smears and old lab results. Your cholesterol level from 2002 will not make any difference, so don't include it. You should never put more than they ask for in your packet. Too much information can actually hurt you, especially when it comes to proving comorbidities. I have seen denials because they found in the medical records that the blood pressure was under control the year before surgery, and it was paperwork that never should have been in the packet because they were not needed. Your surgeon's office should be assisting you with this. As for photos and internet postings, I would not bother, they can be forged, so they will probably not help you. I put all my weights in order, at the top of each I write "patient weight 2002" and circle it and the weight, it makes it easier to spot. I include only what is necessary for approval for several reasons, to make it easier for Aetna to find what they need/require If you provide weights that are obese previous to 2004, you should be ok. Do not be suprised, no matter what you send, that they deny on the first time and you have to appeal. It's no big deal to win an appeal in your situation. If your BMI was over 40 in 2004 and 2006, it is almost impossible for it to be below 35 in between anyway. You will be fine. Good luck! Bonnie

Thanks Bonnie.

Just curious, how long does the appeal process take? Also, I did visit the ER in 2005, but I doubt that they weighed me.  I'm still going to request the record though, just in case they may have written something regarding obesity.

Tiffany, get the ER records and notes, I am sure somewhere, someone wrote "obese" on it. Usually the notes say something like "obese caucasion male in no acute distress" or under the check off section on the handwirtten notes, under abdomen, it might say obese or have it checked off. Most of the time it will be on the notes, even though there is no weight, you can point out the "obese" part. If you get denied it can be one to six weeks to get an answer after an appeal. If you get denied for the weight reason alone, its a simple fix send your letter and pictures, a note from a healthcare professional who has seen you, a nurse who gave you a flu shot, dentist, etc.  would be beneficial, they can attest to the fact you were obese. Don't worry, you'll be fine and on the loser's ebnch before you know it! Bonnie 264/155 RNY 6/3/05

LOL I'm trying not to worry but you know how that goes.  The sad thing is, I haven't even been in for my initial consultation yet!  I just want everything to go as smoothly as possible.

THANK YOU so much Bonnie.  You've been more help than you'll ever know.  I know you are a blessing to your "real" patients.  :)

Bonnie, I wish you all the best in your work to get the rest of your life back! My appeal from Aetna was reviewed and approved within 2 weeks this month. I was then approved and am scheduled to have surgery 2/11/08. If I can do it, so can you! If you need help with Aetna, please don't hesitate to ask as I am nearly an Aetna expert! Good luck, Montanapatient.