A whole lotta questions

So here's my issue....

I have Aetna now and have the option to switch to Med Mutual Jan 1st and have to decide in Oct. I am wanting to get WLS but not sure what to do. I have my first seminar tonight with the bariatrics program I want to use but probably won't get to see doc til sometime in Oct. I have a couple issues. I have only had a >40bmi since recently. I have been around about 38-39 bmi for the last 2.5 years since I had my last baby and fluctuated between 35-37 before that. I do not have any documented comorbidites as of right now but I am 99% sure I have sleep apnea because I snore, always tired and my mom and daughter both have it....I just have never been tested because I also am hypothyroid and my pcp blames everything on that. I also have lower back pain and knee pain both which because I hate going to the doc are not documented with him. I actually besides my gyno before this last year had not been to the doc in probably 5 yrs because I hate going. I also have been participating in a weightloss program that my doctor gave approval for at a gym run by a local hospital whi*****ludes weekly meetings with a Licensed Nutritionist and biweekly hour long sessions with a personal trainer for the last 2 months but no visits with a doc. I have actually gained weight in the program, my trainer and nutritionist blame this on eating more and gaining muscle even if it is healthy since I was someone who barely ate accept junk and lack of sleep since I'm so busy with 3 kids, working fulltime and going to grad school,  which is why I am now at 40.5 bmi I was 39 bmi at start of program. I am under the impression that this program will not count for Aetna's 3 month multidisciplinary program because I have not gone to the doctor during it but wuld count toward a 6 month weight loss program? Is that right? I'm not sure it would count towards any of Med Mutuals 6 month program. 

Which insurance is easier to get accepted by? I have a friend that has Med Mutual that had surgery and she said all she needed was 1 weight in the previous year that she was >40bmi and another friend who has Aetna that said she needed 5 years of >40 bmi. For this reason should I switch to Med Mutual since I will have a weight from 2010 and then when my 6 months is up with them it will be 2011 and will still be >40 bmi? Or should I just try and get the surgeon or my pcp to do a sleep study on me asap so I can see if I have a comorbidity and then the weights don't matter since I have been >35 bmi for last 5+ years?
Also in regards to the supervised weightloss program in Med Mutuals policy I have read WW for 6 months plus 3 doctors visits counts as a supervised weightloss program, I wonder if the program I am in would count if I went to doc 3 times in the next 4 months (since I have already completed 2 months) or would they want my start weight of the program which puts me below 40 bmi?

The moral of this story is what is my best way of getting approved????? I really need this... I ahve tried everything and nothing works for me... I just keep gaining more and more each year.

I also left out I have 6 weeks last Dec/Jan that I went to a doc and was prescibed phentermine and lost 10 lbs in first 2 weeks but then I quit because I didn't lose anymore weight for 4 weeks and it was costing me alot of money. I was at a 39 bmi then too so still not a weight of >40bmi from 2009. I went to Curves for 3 months also in 2009 (Oct-DEc) part of it while I was on phentermine and did not lose any weight besides the 10 lbs in those 2 weeks. I am still a member even though I have not been since Jan of last year since I signed a contract through work for a discount.

Just thought I would add...didn't know if this helps my case at all LOL

Hi,

I have Aetna insurance also.  I don't want to discourage you by all means, but you will not get approved with a BMI of under 40 and no documented co-morbidies.  Even if you go for the sleep apnea test, the co-morbidies have to be present for the two years that your BMI was between 35-39.9.  Otherwise, you have to show a BMI of over 40 for at least 2 years.

There are three of us so far in my family that were approved with Aetna.  Myself and my daughter were approved on the 3 month multidisciplinary program and my son was approved by doing the 6 month physician supervised diet. 

It is my understanding you must be seeing your PCP each month and it documented in office notes.  If you are going going to the gym and seeing a personal trainer you must get it documented with your PCP in order for it to count toward the 6 month physician supervised diet.  Aetna will not recognize it if it is not documented that you went 6 consecutive months to their office.  I was denied at first for that exact same reason before completing the 3 month multidisciplinary program.,  My daughter was also denied, but we appealed on both of us and each time the denial was reversed.

My son did the 6 month physician supervised diet (he actually did 12 months) and was approved within 4 days. 

Given the info you said in your post, I think it will be hard to get approved by Aetna, to be honest with you, only because you don't meet all of their requirements. 

Nan

Ok I did not realize the comorbidities had to be for the 2 years....talking to others who have had surgery they didn't mention this. What constitutes 2 years? Do they use months and years or just years? Like if I have a weight for 2010 at >40 and then at the end of my 6 month diet have a 2011 bmi of >40 is that all they look at? I ask because my friend that has Med Mutual had a baby in Jan of 2008 had her first weight of bmi>40 (previous to baby she was around 35 bmi) in the summer of 2008 then had surgery Oct 2009 and was approved.....this was only a period of about 14 months not 24 months...they just wanted a 2008 weight and 2009 weight.

I am pretty sure they mean 24 months.  For example if you weigh in in Oct 2010 at >40 and then expect surgery in 2011 after doing the 6 month supervised diet, they will want to see a weight from 2009.  My daughter's exact denial letter read 'denied due to lack of proof of obesity present for 2 years'.  We went back to 2007 and proved weights from 2007, 2008, 2009 and 2010 of her BMI >40 in the appeal and won. 

Thanks for the info. I guess my choice is clear...switch to Med Mutual because they only require weight at 12 months of >40 bmi before application date and if I have a comorbidity after testing I can apply for surgery after 6 months of diet and if I not I can apply a few months later.