Aetna - BMI requirement - no proof

What in the heck am I supposed to do if I don't have a record of my weight for the past two years?

Do they actually need written proof from a doctor? The last time I saw my PCP was 3/15/07 (and my BMI was below 40 anyway so that visit is useless to me) and nothing since then until last month.

Any ideas?

They probably will require written proof from a doctor, yes.  One thing you could try is sending pictures of yourself over the past two years, if they have the date stamped on them and if it is obvious in the pictures that you are overweight.  I have heard that some people have been able to use that to prove a history of being overweight.  But I'd say it's a long shot.

Kelly

Yeah, I can't see them accepting a photo as evidence.

I feel sick.

Why don't you try calling them and explaining the situation and ask if there is anything you can do?  You might want to ask to speak to a supervisor.  The person who answers the phone may not know how to help, but a supervisor might.

Kelly

Thanks. I am going to try that and also call the surgeon's insurance coordinator to see if they have encountered that problem before. I'm not sure there is a point in doing the 3 month multidisciplinary program if I won't be approved anyway because of this one thing.

Might be back to WW for me. :(

You said, "MIght be back to WW for me."  Have you been going to WW over the last few years?  Or have you been going through any other weight loss program where they have documented your weight?  I have seen that used in the past successfully!  Good luck!  :)
Best Regards,
Kim

www.bliscompany.com

 are you very over weight?  If so you can use the logic that hey, I didn;t get this fat over night?

LOL! You would think they would realize that, huh?

I am just a tad over a 40BMI and, to be honest, I have to work to maintain my girlish pre-op figure. If I lose so much as 7 lbs, I will be under their requirements.

I did WW last year but I was around a 37 BMI so can't use that weight!

I am going to go ahead and do the 3 month multidisciplinary program and have the doctor submit me for approval. I'll fight them if they deny me. Nothing ventured, nothing gained! (or lost in this case)

Hi, Mandy, I feel your pain.  I have Aetna as well.

I stepped off the lose/gain diet rollercoaster in 2008.  The first qualifying weight I have is BMI 40 on December 4, 2008.  I did the 3 month discliplinary diet fully aware that I would probably be denied since I lacked the required weight history.  I did the diet April - July of 2009 and submitted to Aetna.  Sure enough I was promptly denied due to no physician proved weight history for 2 years.  I was pretty sure that was going to happen so I had continued seeing my surgeon and my dietician every month until I had 6 months worth of visits.  That way my 6 month diet requirement is fullfilled and the 6 month diet is good for 2 years (the 3 month diet is only good if done "proximate" to surgery).

I still see my dietician every month to keep in touch with the program and to keep my weight history going.  I'll be submitting to Aetna again in December of next year (2010).

If they deny you, settle in and keep your head in the game.  Some people wait years and years due to exclusions so I feel grateful that the coverage is available to me even though I have to play by their rules.

I had the same problem. I had no weight history for 2008. I had lost weight over 50 pounds and had no need to go to the dr because I was feeling good. But I actually ended up pregnant in 2008 and had weight for the 1st month of pregnancy where my BMI was under 40 which didn't count. I called Aetna and explained the situation. They then told me they don't count pregnancy weight so I went back 3-4 years prior for weight history. I had records up until 2005 and had planned to go back even more if it helped. I think you need to call them and explain you didn't have weight for just that one year but can prove you where overweight the years before. See what they tell you. But stick to the 3 month plan and appeal if they deny you.  It might work like it did for me. Hope this helps. Good luck.