Aetna documented weights issue

Hello All,

 

I have Aetna and I am nervous about one part of the clinical bulletin...The 24 months documented weights. I have been obese my entire adult life and in 2009 my doctor advised me to lose weight. Well, I did. But an injury in 2011, caused me to be unable to workout for a while...you know the rest...Here I am today, I gained it all back plus 13 pounds! In 2011, my bmi was below 40 (37.4 to be exact). I have no comorbidities that I know of (sleep study is next week). I am currently at BMI of 43 or so. Anyone, have this issue? I am gathering weights back to 2006 to show I didn't just become obese lately. Oddly, one of the requirements is that you actually had to try to lose weight and be unsuccessful. *Sigh* This is so frustrating! Any advice is welcome!!!

I feel ya...I have to somehow get 5 years together. It's going to be hard! In 2011 for example, my BMI dipped way below 40 from a severe unhealthy crash diet. But unfortunately it was during that time that I have any documented Dr. office visits :/

Other than that ONE year, I have always been in the super morbidly obese category.

KristenRB82,

 

What type of insurance do you have? They require 5 yrs history?

I have United Healthcare Choice Plus PPO.

Idk why they require that :/ I've called several times and the reps always tell me it isn't required, however the office coordinator for my WLS surgeons office says it is. So I'm kinda stuck.

Maybe they just like to submit more information to show a pattern...

I was required to show the same on the same program. Look carefully at your contract - mine did not say 5 consecutive years, only 5 years. So, I pulled 5 nonconsecutive years.

Good luck!
Laurie

I just had another thought - the clinical bulletin is, at least in UHC's case, very different than your plan document. UHC had issued a clinical bulletin - available on the web - that said in general, WLS was reserved for those with BMI of 40 and no comorbids, or BMI of 35 with comorbids. It also said that the individual contract under which an insured is covered trumped their clinical bulletin.

My individual contract required a BMI of 40 with no mention of comorbidities, period. Plus, it required a 5 year history of morbid obesity. And, that is what "won" when it came to deciding my preauthorization approval.

Hopefully this illustrates the importance of getting your contract vs a clinical bulletin. MAKE SURE this comes from your employer/the organization that you pay for your healthcare.

Laurie