No Comorbidies BMI>40 will Aetna Approve?

I am on the lower weight in but not for my height I am 5'1 and weigh 216. My last 5 years weight was as high as 265. I am unable to get below 40. I am concerned with Aetna and how they may view it. I have seen other patients on the site that has had a weight in the range of mine, and they have had the surgery. I am just concerned whether or not Aetna will see it that way. I am doing my 3 month pre-diet as that is part of there stipulation, and have already had my psych eval. I just have to wait 3 whole, long months until I know that I am in the clear. Just curious if there is anyone else out there that weight was in my range and recieved approval?

ok i know that i am about to offend some people and probably even you but i can't help it this is just my opinion.... bmi of 40 and no related health issues.... why would you want them to rearrange your intestines? 215 is not that big with no related health problems why not just join a gym,  and maybe start going to weigh****chers.... there is a reason why no insurance company will cover someone who's bmi is 40 with no related health issues... and that is because insurance coverage is based on MEDICAL NECCESITY.... sorry i just had to say it... I know i have a big mouth and i'm honestly not trying to be mean, but wls is an extreme step.

Now thats the first time I heard that before...Not.  I am not at all offended, and yet I took the liberity of reading your story, and it is no different from mine other than I am 3 years older than you and currently your BMI is at 49. Mine has been as high as 51 at one point, and I did what you said..let me see how you put "why not just join a gym,  and maybe start going to weigh****chers". I have done all of those things and I am still obese. I figure my good health comes to me playing alot of sports through out my school years, but that doesn't mean I don't have a chance of developing the co-mordities that run in my family. So I rather get in front of this rather then being behind. Also I don't have what you would call a major co-mordities, and I would classify that the way my insurance does, which is diabetes, hypertension, and sleep apnea. Thank God we have the right of choice, because to me and the frame that carries 215 lbs it is" that big". I wish you luck on having your surgery and I hope your journey to a slim and healthy happiness is joyful. 

Well said Md.  Some insurance companies cover WLS for individuals with BMI of 40 and above with no co-morbids.  I guess this is due to the fact that sooner or later idividuals of this size will have problems down the road with serious illness.  I think it is a good thing that you are trying to get ahead of it before u develope some of these serious illnesses.  Just do you girl! Don't worry about some of the thoughtless reponses people make on these boards.  AT 5'1 and over 200 lbs anybody with common sense would know that you are seriously over weight.  Good luck on your quest!

I have Aetna. I was over 140 lbs overweight at the time I requested approval with no co-morbid factors- I was initially denied for the 6-month dr supervised diet plan.  I completed that long 6 months (and may I suggest continue to go to support meetings while you wait for approval- the more you learn, the better your chances of success) and I resubmitted my claim.  Again denied- you can imagine the tears and frustration. this time, it was because during my last five years, my weight had dropped below the required "at least 100lbs" overweight by two pounds!.  I had appeal letters written by myself, my mother, my best friend, a co-work, my pcp, my surgeon and a report on the statistics of health issues caused by obesity- they finally made what they called "an exception" to grant me approval because my weight had increased so much overall in the last few years.  All I can say is hang in there and DONT GIVE UP!! You have to do all your own follow-up letter/documentation gathering, all your own phone follow-up etc.  You have made the decision to change the quality of your life- don't let others treat you like you dont have that right!  I waited, fought and jumped thru every hoop they put in front of me and was finally in surgery after 11 months!  I am 3-months out, 58lbs lighter, working out everyday and believe me- every phone call, every fight, every month I had to wait was well worth!  Good luck!

Hello, I don't have anything definitive to tell you about the insurance.  I have Aetna and I'm also seeing Dr. Yasrebi for my 3 month pre-diet (and hopefully my RNY).  If your BMI is 40 or higher you don't have to have any co-morbities.  A BMI of 40 is a significant amount of excess weight no matter how tall or short you are.  When I started my pre-diet with Dr. Yasrebi I was well over the required BMI of 40.  I'm concerned about insurance denial if my BMI drops below 40 during this pre-diet.  I have co-morbities but not the ones that Aetna specifies for BMI's 35-39.9.  Michelle (Dr. Yasrebi's office manager) assures me that it won't be a problem.  The insurance determination should be based on the BMI you had at the time you started the pre-diet.  Since they also require that your BMI be over 40 for 5 years, Michelle said that she will only submit the highest weights recorded during that 5 year perid.  I've dieted a lot so I was concerned about my BMI dropping down to 38 a few years ago.  During the same year I also had higher weights, so those are the records they'll submit.   Anyone that has had a BMI of 40 during each year for the last 5 years definitely needs help.  I wish you all the best of luck.  Please keep in contact with me.  Hopefully neither one of us will experience insurance denials, but it would be nice to help each other if we do.