Question:
No weight documentation

My insurance, Aetna premium PPO, requires a documentation proving morbid obesity for at least five years. The doctor that I had in 1998 and 1999 did not record any my weight at any time. I have one weight recorded in the fall of 1997 but it is 226 lbs., seven pounds to little to be considered morbidly obese. The only other weight I have on record is in March of 2001 at 245 lbs. If I go off of that I would have to wait till March of 2006 to have my surgery. Two years away! When I called Aetna for advice, I was told to submit what I had and see what happens. Real helpful. I first reached the morbidly obese stage in the spring of 1998. On my medical records at that time there is a notation that says something to the effect of: "patient is complaining of fatique and joint aches due to weight gain." If I submitted the weight record of 226 lbs. taken in the fall of 1997 along with the notation mentioned above, and if I included a letter explaining that in the spring of 1998 I had reached a weight of 235 lbs., I wonder if that would do the trick. Any advice?    — Lynda D. (posted on March 24, 2004)

March 24, 2004
Aetna PPO is also my insurance and they are very METICULOUS when it comes to meeting their requirements. I was initially denied last Dec. and am about to reapply next week. I would still submit to them EVERYTHING you listed and a concisely written letter explaining your situation. You never know who will be reading it and making the decision that day! IF you are denied they will send you a letter telling you why and you can appeal. Best of luck to you! Leslie Lee
   — leslee4567

March 24, 2004
I had replied to you when you posted this on the message board, but in case you didn't see it..... If you have any co-morbidities such as high blood pressure, diabetes, sleep apnea, you only have to have a BMI of 35 to qualify with Aetna. Rack your brain and try to come up with any time you might have been weighed - ob/gyn, WW or other weight loss program, work related physical, urgent care, emergency room, etc.. See if your doctor will write a letter stating that you have been obese/morbidly obese for XX number of years. Good Luck
   — Carolyn M.

March 24, 2004
Submit to them what you have! I was 9 lbs under BMI of 40 five years ago, but they said that was close enough! If you get turned down (and expect to get turned down, Aetna is famous for turning down WLS on first attempt) but get to a case manager and they will help you through the process. The biggest thing you have to be concerned with Aetna is the 6 month DOCTOR SUPERVISED weight loss with NUTRITIONIST. That is what they deny for most of the time.
   — Michelle A.

March 24, 2004
Oh yeah, the other post reminded me too. The one wieght I had from five years ago put me at BMI just under 40, with no comorbs at the time. BUT, I had totally forgotten I got weighed. I was goign by doctor visit alone, but remembered I had applied for WIC right after my daughter was born. It was from the health department and they accepted it! Think of ANY time when your weight might have been documented and you might have been a few pounds heavier.
   — Michelle A.

Click Here to Return