Question:
My company doesn't consider morbid obesity enough reason for WLS

   — Amelia L. (posted on November 20, 2003)

November 20, 2003
I was told that my knee problems would be a co-morbid so I would call and ask Aetna what they consider co-morbids and what they do not. Hope you are able to have surgery and good luck with your journey. 6/27/03 292/202/172
   — horserider0146

November 20, 2003
Amelia, I hope there is an easy answer for you out there somewhere. For me, there wasn't. We went through trying to get insurance coverage for my surgery (DS) through two different insurance companies. Even with certified letters stating that my life would be over within months due to my SMO status and the associated co-morbidities from all 5 of my medical team physicians/surgeons they denied coverage - and legally, there were no loopholes. So, we self-paid. I know it sounds like I say it flippantly - like anyone can just drop down that kind of change, but honestly, we couldn't. We own no home, we have no property, we have no savings - in short, we're pretty much broke. But someone - thanks to God - anonymously donated the $15,000 necessary for me to fly to Spain and have my surgery with Dr. Baltasar. It was one of the best things that has ever happened to me in my life. If you'd like more information, you could check out www.bodybybaltasar.com - or email me any time! Blessings, dina
   — Dina McBride

November 20, 2003
Your depression is a co-morb. You need to be on medication for it though. So, go get some if you don't take anything. Joint pain on a consistent basis is a co-morb- ask the doctor for a perscription pain reliever like perscription motrin or vioxx. You should be tested to Sleep Apnea. Tell your doctor you wake up very tired and fear sleep apnea and go get tested. The leg swelling (Edema) can be a co-morb. Got to talk to the Dr. about this. Also, do you get acid reflux more than 1x a week? You may have GERD, which is a co-morb. You can get a perscription for that too. Getting the gist of things here? First, you have to talk to your PCP. Then he has to treat you for some of these things. Sometimes, we just don't complain enough to get these things treated when we should. So- go talk to your PCP!
   — LMCLILLY

November 20, 2003
If you go through the "journey" page of this website you will see many co-morbids and a sample letter.
   — M B.

November 20, 2003
Yes, Aetna does require a six month DOCTOR SUPERVISED DIET (including monthly wiegh ins and visit with nutritionist) Go to Aetna's website and do a search on obesity surgery. They also do require a comorbidity. Sleep Apnea IS a comorb, as well as high cholesterol. Also, if your BMI is over 40, having a parent with heart disease is a comorb. You may have more than you think you do. Get tested for sleep apnea and go ahead and start on the six month diet so it is out of the way sooner. They will NOT approve it without it. And they probably will deny you the first one or two times. I was told that WLS is an "automatic denial". Basically, they aren't going to pay lightly, you are going to have to fight it. They WILL cover it, but not without a fight. I guess they want to make sure you really really want it and aren't just in there on a whim.
   — Michelle A.

November 24, 2003
You have to remember that if your company has an exclusion the company has to change it's contract with Aetna. That was my situation until my husband's contract was radified and included WLS. I'm 2 1/2 yrs post op with Aetna MCN. My BMI was 40 and I didn't have High BP, Diabetes, or Sleep Apnea. I needed 2 medically supervised diets and luckily I had that. My bad back, my GERD, my feet hurting all the time, swolled ankles and things like that were comorbids that I qualified for. I also needed to supply them(Aetna)with all I had done to loose the weight like going to the gym, Weight Watchers etc...They are not included in the medically supervised diets. I also used the weights from when I went to the OB each year(on their letter head).So, I bet you have comorbids that you didn't realize. Best wishes
   — Linda M.