Newbie trying to figure something out about Aetna?

Ok, Please somebody help me out here. I have researched a ton of previous posts on Aetna and what their requirements are, but somewhere I am getting confused. See if I understand this correctly please.   Aetna has now changed to 2 years weight history instead of 5?? Does that mean we have to have documented proof of a BMI over 40 for 2 years or 5?  And do we also have to have a co-morb? Also we need a 6 month diet or some 3 month pre surgical doc approved diet? Can someone please answer this question also...What if I have documented weights for 5 years, but not all of them are over 40 bmi, should I dig those up also? And here is my problem.  I had a bmi of 38.5@ one point in 2007 (someone on another post for someone else, said just to send in my highest weight).  Then all my other weigh in's were well over 40.  And the tricky part of my problem is this, I was pregnant in 2007.  Will that hinder my weight records?  Do they even have to know that? I mean I can just send them weights for 2007 and 2008--- trust me I do have plenty, and what they dont know wont hurt them right?  They have no idea I was pg then, b/c I never used Aetna for any part of my pregnancy. Never even had a policy with them then.... I am sooo terribly sorry for so many questions in one post.  I just dont understand the weights for 2 or 5 years and what kind of weight will be considered acceptable. Like, do all my weigh-ins need to be bmi over 40?  Thank you guys for taking the time to read such a long post.

I'm going through the pre approval process with Aetna right now. Only need 2 years of diet. I have the same problem as you also so I am very interested in the replies. In 2006 my BMI is 38.5 also but 2007 and 2008 over 40. I have no comorbids so I need it to be over 40. I wonder if they deny me for that reason. If you have any comorbids you can have a BMI as low as 35.  I'm doing the 3 month multi-displinary program with my surgeon's office. I meet with a nutritionist, thereapist, and excersise consultant. 12 sessions total, but it includes my psch eval and nut consult. Soooo ready for it to be over! Not sure about the preggo part. My philosophy would be like the military...don't ask don't tell!

I have Aetna as well. For the weight history you only need two years so 2006 and 2007. In those two years your BMI must be over 40. If you have a co-morb you can include that as well. If you went to the doctor multiple times in the year just get a copy of the visit where your weight was the highest. For the 6 month or 3 month diet make sure you have a surgeon that knows exactly what the needs. The 3 month diet means that you have 2 appointments a month instead of 1 for the 6 months. Let me know if you have any other questions. Good luck!

The last post is right, only submit the highest weight for the last 2 years. One weight for 2006, one for 2007 and choose your highest. If you do not have co-morbidities, it needs to be above BMI of 40. MAke sure you are accurately measured in height---many people have not nbeen measured since they were 12----it does affect your BMI, and 1/2 inch makes a difference! And it does not matter if you were pregnant, if that's the only weight you can get. You do not even have to submit medical records, your docs can write your name, date and weight on a perscription pad and sign it if you prefer, insurance companies will accept that as proof of weight as well. I am a nurse for a bariatric surgeon and get people approved for WLS every day. Aetna's 3 month program is specific, read their policy for it here: http://www.aetna.com/cpb/medical/data/100_199/0157.html It has to be 90 days long, not just 3 months---I had one lady get denied because it was 88 days. You need to see your doc for an assessment (see criteria D 2) and get a letter for Aetna "Susie Q has started a multidisciplinary surgical preparatory program to inprove her pulmonary reserve and improve surgical outcomes. She is working with nutritionist xxx and is exercising 3 times per week by swimming, gym, etc" T hen you see a nut and get a eval. Then you see the nut every 30 days for weigh in and make sure  the nut documents the weight and exercise you are doing.  Then on day 90 (or later) you see your doc again and get her assessment of completion: "Susie Q has completed a 90 day multidisciplinary surg prep prog designed to increase pulmonary reserve and imporve surgical outcomes (take the wording from their policy). She has been compliant and has made significant positive shanges for her health. I recommend proceeding with WLS". Submit this stuff, your psych eval and letter from yur surgeon requesting surgery to Aetna's fax and you will have an answer in 2 weeks or less. They are fast and good to work with if you do it right! Good luck! Bonnie

I have an Aetna HMO policy and had a really hard time getting approved.  You only need 1 documented weight for each of the past 2 years, so make sure you get your family physician to write a letter of support and include only the highest weights for each year.  If your BMI is 35 to 39 Aetna will only approve it for certain comorbities, ie: diabetis, hypertension that is not controlled with medications and sleep apnea.  I was denied 3 times and finally requested a formal hearing.  I represented myself at this hearing and presented my case to 6 unbiased "medical experts".  My BMI was 39 and I did have hypertension, fatty liver and and enlarged heart (all which Aetna originally would not accept as good enough).  I fought Aetna tooth and nail to the very end and at this formal hearing I finally won and was approved.  I had gastric banding surgery on 4/23/2008.  Do not give up and keep fighting.  Aetna counts on their clients giving up before they have to pay for the care that you deserve.  Taking as far as you have to.