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.
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