Will I have to do this all over again with Aetna?

jynxxx
on 3/15/09 4:06 pm - fulton , MO
I have aetna insurance and right now I'm doing my 6 month supervised diet. I'm pretty sure I'm going to be denied because my BMI hasn't been high enough for long enough (2 years).  If I do get denied and wait at this weight for 2 yrs. to have surgery, will I have to re-do the supervised diet because it will be so long between now and then? Or will it be fine since I will have completed all the requirements?
bonnied
on 3/16/09 11:16 am - St. Albans, VT
You only need to submit one wieght for 2007 and 2008, not each and every one taken. Review your records carefully and pick out your highest weight for each calendar year. One could be december and one 2 months later, it does not matter, just one for each calendar year. Many people have weights below the needed BMI a some point during the year because they have been dieting. Ususally we can find a random high one that meets the requirement!
You will have to redo the diet if you have to go 2 years from today. Most insurances want a recent diet. Some do accept within 2 years (my husband's policy did), read aetna's obesity bulletin on their website for details.

Good luck!
bonnie
Hi -- The way I read our policy and Aetna's Clinical Bulletin, one has to do the 6-month "we hope you'll go away' trial UNLESS your BMI is over 40 or 35 with co-morbs.  To read about this go to
www.aetna.com and search Policy Bulletin 0157.
(deactivated member)
on 3/17/09 11:28 am - Woodbridge, VA
Huh? No, you have to do the 6-month diet or 3-month multidisciplinary program for Aetna regardless of BMI. If you don't have a BMI of 40+ or 35+ with co-morbidities, you don't qulilfy for weight loss surgery at all.
jynxxx
on 3/17/09 3:54 pm - fulton , MO
I know I have to do the 6 or 3 month diet regardless. I just had a sleep apnea test done and I only have mild (not even moderate) sleep apnea. And from what I can understand on their policy bulletin is I don't think it's severe enough to count as a co-morbid. So I have no others (co-morbid). I don't think my BMI has been forty for that long so I was wondering if I finish my supervised diet now if I to wait for a while for the 2 yrs of 40 BMI will I have to redo this diet closer to the end of my 2 yrs. Wheeeew. I'm sorry I'm making this sound so complicated, I KNOW what I'm asking, just finding the wording is difficult.. B-U-T ... if aetna does go by 08' and 09' , not 24 total months then I might be good to go! Thank you everyone for all the help and answers. If I didn't ask here I don't know where I would ask, because I've called the people at aetna and they didn't really answer ANY of my questions. THANK YOU ALL SO MUCH!
sheepla
on 3/18/09 12:06 am
You're going to need a weight from some time in 2007 as well.
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