Aetna Possible Denial

Here's my situation, in years 2007, 2008 and at present, I have documentation that my bmi was 40 or above.  I have not been diagnosed with any co-morbidities.

I'm am missing documentation that my bmi was 40 or above in year 2009; my weight documentation shows that I'm 2-3 lbs below 40 bmi.  I was trying to lose weight to help with GERD symptoms.  Since I'm now at a 41 bmi, you can see how well that worked for me. 

It's possible (although doubtful) that I have some WW documentation for year 2009 showing me at a higher weight.  As soon as I can dig out from some home improvement work, I can get to the WW records to check.

If you have Aetna experience, do you think I'll be denied because of my weight in 2009?  From what I've been reading, I think I will be.

Kim

I also have Aetna and was intially denied. My 2008 weight from my PCP was a few pounds below their BMI limit. Even though I had a co-morbidity  (sleep apnea) I was denied. My surgeon did a peer to peer review and I was once again denied. I searched far and wide for another doc's report showing my weight higher and appealed. That was all it took.

So, for Aetna, I would try to find another doc's report with the needed BMI or see if you have sleep apnea (a common CM for obese people).

My surgeon said that Aenta used to be easy but seem to be pinching tight here lately.

Hope this helps...

I have Aetna PPO.. my BMI wasnt the problem it was having 2 complete years showing it and they want no gaps. If you know you are going to come up short they will likely make you do the 6 months of assisted weight loss.

I was approved on first submission but I had known going in what would be needed so I started going to my PCP almost monthly.. 

Good luck!

Kim,

You need to try and find the WW stuff.  My daughter had exactly the same scenerio as you and was denied.  She had office visits during one year where her bmi dropped below 40 as she had been trying to lose wieght.  She was denied.  When we appealed, we resubmitted all the paperwork omitting that office visit where her bmi was lower than 40.  She had other weights in the same year where it was over 40.  She won her appeal and had her surgery! 

So my suggestion to you would be if you find the WW stuff, send in the documentation from 2007, 2008 and present and the WW stuff from 2009 but don't send in the other documentation where it dipped below 40.

Nan