BMI requirements for Aetna

Since I was a teenager I have had a BMI between 35 and 39 with a few good weight loss runs that put me below and a few pregnancies that put me over. I have no co-morbities but my Mom died at 49 and my Dad died at 51 from obesity related issues. I am 36. This past year I have hovered between 40 and 41.  Last year  2012, I was pregnant and my only weigh ins were while pregnant and my post partum visit weigh in  I only gained 25 lbs (1) can I use any of those weigh ins to count?  (2) my BMI was only 38 still morbidly obese but not above 40.  In 2011 while I do have non-pregnancy weights my BMI was still only around 38.  Has any one used pregnancy weights (first visit or post-partum visit) and has any one been approved not proving a BMI of 40 over the last 24 months?

TIA

I don't have an answer for you, as I had a BMI over 40 for the required time period.  But, I wanted to wish you luck! 

Hi,

Yes, they are very strict when it comes to the restrictions. You have to prove a BMI of over 40 for at least a 2 year history or they will deny.  Myself and all three of my kids have had the surgery and were approved through Aetna.  Two of us were originally denied and I had to appeal to get approved but in all four cases, we had to prove that 2 year history of >40 BMI. 

My daughter was denied at first because she had one office visit where she slipped below to a BMI of 39.  She was denied even though she clearly had a BMI of >40 for 4 years.  But because of one office visit in one of those years, she was denied.  We put together an appeal and simply didn't submit that one office visit in the appeal and she finally got approved.

Nan

I have now been diagnosed with sleep apnea wich is a co morbity and a few other sleep disorders that don't meet the Co morbity requirements. Does that make a difference or must I have sleep apnea for two more years? My Pcp told me I should be good now to meet the requirements.

Thanks so much for the input!

Do you have a copy of Aetna's clinical bulletin 0157??  That gives the specific requirements that you need to meet in order to be approved.  If you go to Aetna.com and in the search box type in 0157 it will bring it up. 

I do have it, it just isn't very clear on how long you must have the co-morbities...