Aetna and my BMI

I'm trying to figure out how to word my question. Aetna requires one to have a BMI of 35 w/ comorbids or 40 BMI  for 2 yrs. Well 2 yrs ago I was 35 BMI w/out any comorbids but now I'm 40 BMI and still no comorbids. My question I guess is... if my doctor does find a comorbid now will it still count back from when my BMI was 35 or will I have to wait 2 yrs from when I became 40 BMI??? Sorry my question is confusing, I didn't really know how to word it!!!

I'm in the process of getting Aetna approval so have studied their requirements in detail.  I think if you have a comorbidity now, a BMI of 35 for the past two years is fine. I have never seen or heard that you have to prove you've had the comorbidity for the past two years.

I think the requirement is just to "prove" that you've been morbidly obese for at least two years. Some insurance companies require 5 years. I don't think that they could require you to have comorbids two years ago because :1) what if you didn't have insurance 2 years ago, 2) what if you did have comorbids but you didn't see the doctor and didn't know about them. I've heard of some people who didn't have insurance using their driver's license picture, family pictures, WW weight in cards to prove they were MO in the past. I wouldn't worry too much about this as long as you have proof that you were MO (especially doctors charts). Best of luck to you.

On their site they only list a few specific comorbids. Do you know if they would consider any others like PCOS? Or something else?
 

I have called Aetna several times but it seems like I always talk to someone who doesn't seem very good at answering questions. They just kinda act like "well figure it out for yourself!" They just tell you to look at the website for answers. I say I have and that's why I'm calling is because I have questions. They just keep avoiding me and tell me to go to the site.

Aetna is very good at refering you to their website which SUCKS and is very hard and confusing to navigate.

I believe PCOS is a co morb I am not 100% on that though.

DO you have sleep apnea, high blood pressure, thyroid issues etc etc.

It is very unusual I think for an obese person to not have some kind of co morbids.

Have you checked with your PCP and asked them the questions if you have any?

Do you snore? If so you could have sleep apnea and should ask to be referred for a sleep study.
Do you have:
high blood pressure
high cholesterol
stress incontinence (you leak urine when you sneeze or laugh)
joint pain or swelling
PCOS should be considered a comorbid because it's usually caused by obesity
heavy/ no period
diabetes
insulance resistence?

I DO snore now. All the time when I lay on my back. My doctor has kinda given me the run-around. A while back she said I was borderline type 2 diabetic and if I gained more weight (which I unfortunately have) I would be. She said I have all the symptoms of PCOS but won't say I actually have PCOS. I just did some bloodwork and have slightly high cholesterol. It's frustrating because it's like she acts like she doesn't want to DIAGNOSE type 2 diabetes OR PCOS but I can tell she thinks I do.  She even had them do an ultrasound on my ovaries and said that even though she didn't see anything that it didn't mean there wasn't something wrong. WTF???And she's all for me having WLS so I don't see why she wouldn't want to diagnose me with anything.

Do you see any other doctors who might be more willing to help you out? A gyn? An endo?

If you are even "borderline" type 2 diabetic, then you're likely currently insulin resistant, as that is the precursor to type 2.

PCOS is kind of hard to diagnose. It has been mentioned to me multiple times over the years (hello, emergency surgery for 10-inch ovarian cyst when I was 16, irregular menstrual cycles, and now type 2 diabetes), but never formally diagnosed. It's one of those things that is usually determined sort of on the basis of eliminating other possible problems. There's not really a test you can do to say yes or no if you have it or not; it's just kind of a group of symptoms.

Oh, and see if you can get a copy of your doctor's notes from your visits. It should include a section of any ongoing diagnoses. You should be able to see there if you've been technically diagnosed as having high cholesterol.

And honestly, I might try to find another doctor, one who will really help you get to your goal of having the surgery. If there re any WLS support groups earby, I suggest attending one and asking for doctor recommendations from them.

No, she's the only doctor I go to. I have been there (her office) several times to try and get the ball rolling and try to figure out where to even start. I mean do I need to find a surgeon first or will my pcp submit stuff when I'm done w/ the supervised diet or how do I get started with any of it. I'm never gonna know if I will be denied if I don't know where to start. I haven't started to do the 6 month thing yet but I just don't even freaking know where to begin. When I've went there (doctors) they act like they don't submit anything anyway.