Aetna - BMI requirement - no proof

Hello- So I'm new to WLS and just gathering information... my question is with the weight history you have to have been over the 40 bmi for the whole period? I've always been around 37 bmi until the last 6 months or so....does that mean I wouldn't be able to get surgery for another 1.5 yrs?

Thanks!

Pretty much if you don't have any prior health problems related to being overweight. You have to show the last 2 years with a bmi over 40. I hate to disappoint you but hey give it a try.

I also have Aetna... Do you know if just a simple weight from a Dr. 2 years ago is what they are looking for?

I have also been on a supervised diet/diet medication regimem with a GP for the past 6months - do they want proof you've been trying?

Thank you :)
Nicole

I have Aetna HMO and since I had not been to the doctor in 2007 or 2008 (but went loads of times in 2006 when I was pregnant) I'm having some difficulty with this too. I saw my PCP in March 2009 and the surgeon's office says that plus a visit in 2010 (which is just around the corner!) should work, and I'm planning on going to this 12 week program at a local hospital, since the surgeon is about 4 hours away. Also, the surgeon's office asked if I had photos... I even posted here asking if anyone had used that for proof before. Unfortunately, the few photos I have are not date stamped and are only digital photos. But, they aren't of just me, I have my kids in the pics and even grandparents who I haven't seen often since they're a good 1200 miles away. I decided to just be safe about it and wait until 2010. Just in case you have to wait a while too, it might be a good idea to get a doctor's visit out of the way and get that weight proof started! My biggest fear about the whole thing is the possibility of insurance changes while waiting.

Anyway, I've been on the phone with an Aetna rep and she talked to me for a while and offered to send me a page that shows all the info they're looking for. A 5 year weight history is listed! Under "Required Documentation" here's what it says:

1. Member BMI (Body Mass Index)
2. Member current height and weight
3. Member age
4. Length of time the member has been morbidly obese (# of months or years)
5. Clinical records documenting the medical/dietary therapies (within two years prior to surgery) by an attending physician who supervised the member's participation
- Documentation of a 5 year weight history
- Documentation of any medication that was prescribed by a physician to assist in weight loss
- Co-morbidities (including Diabetes, CAD, obstructive sleep apnea) and cardiac risk factors such as smoking, HTN, hypercholeserolemia, family history etc.
- Surgical consult report indication need for surgery
6. Documentation of pre-operative evaluation and clearance for members who have a history of severe psychiatric disturbance (e.g., schizophrenia, borderline personality disorder, severe depression) or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medication

Well, that doesn't say 5 years at a certain BMI so maybe just proving you were MO for the past 5 years is enough, but they want 2 years at >40 BMI...I don't know. I have documentation that they sent me that just states 2 years.

I might switch to Kaiser anyway at this point. I am still deciding several things so I'm not sure what I'm going to do.

eta: here is what Aetna sent me and it's pretty specific
http://www.aetna.com/cpb/medical/data/100_199/0157.html

   I also have Aetna. My surgeon's office submitted on Monday, now they are asking for more documentation. 1) a letter of medical necessity, 2) a 2 year weight history 3) 6 month physician supervised weight loss documentation. What I am really confused about is that their requirements say either 6 months supervised weight loss OR 3 month multidisciplinary. I have completed the 3 month multidiscipinary, so why are they asking for 6 month supervised weight loss??
   My insurance says they left a voice mail with the insurance coordinator, and also called her today to ask if I need to do anything, and I have not heard anything. I will giver her until Monday. She is highly praised in the "world of insurance approval" at my surgeons office, so I am holding on th the hope that she has it under control.