Question:
what is considered

I am currently waiting for approval from my Aetna PPO provider but am concerned about a possible denial based on the 5 year Morbid Obesity rule they have. I have doctor notes that I have provided showing MO from November 1998, 1999, 2000, 2002 and 2003. However, my BMI in 2001 was at the time I went to my PCP for a visit once that year was a 34. I had just had my child and lost a lot of weight after having him.....a shock I know but true! Because I do not show I was MO that year but rather just Obese, does that disqualify me??? Also, are they looking for a "full" 5 years meaning from November 1998-November 2003??? Or just a record showing that in 5 fiscal years you have record that you were MO??? I have the latter of the two but if they are counting month by month I'll be denied because my 5 full years end this November. Can someone please help clarify or offer some insight?...Thanks!!!!!    — Lola C. (posted on July 21, 2003)

July 21, 2003
Most insurance companies are looking at your records to see if your BMI was above 40 during the past five years. So basicly if your BMI was, you shouldn't have a problem. You may run into a problem during 2001. I have seen some insurance companies deny because of that. (BCBS for one always denies for that reason). If you have other health problems, they may over look 2001 because of you being pregnant. My sister had the same thing happen, after she had her baby she dropped 50lbs! If I can help any more let me know! Hope this helps, good luck!
   — Ashley S.