Approved with Aetna

B Girl
on 6/4/07 6:56 am

Hello everyone! I just wanted to let you all know that I was approved today for RNY. My request was sent to Aetna Wednesday afternoon and approved a few hours ago. The waiting game was the scary part for me. I'm considered a "lightweight" and wasn't sure I'd get approved. Here's my story.... I've had a BMI of 40 or higher for five consecutive years. Technically, I have gotten below BMI of 40 in the last five years. My surgeon only supplied the highest weights since those other diets obviously failed me. I have back pain, knee pain, stress incontinence and chronic headaches. Aetna doesn't recognize any of these to be valid comorbities. They look for sleep apnea, hypertension, diabetes and heart disease. I completed the psych and nutritional eval as required. My biggest concern was falling below a BMI of 40 during the medically supervised diet. I started with a BMI of 42. I was required to see my surgeon every few weeks for 3 consecutive months. My BMI dropped to 39 during the diet, but went right back up to an even 40. I was approved, so it must have been within their guidelines. WOO HOO

winterberrylane
on 6/4/07 2:15 pm - New York, NY

RNY on 07/12/07

hi, what type of aetna do you have? (hmo, ppo, pos)? & what state are u in? i have an aetna hmo in ny & my paperwork is being submitted this week and i am VERY nervous.

http://tickers.tickerfactory.com/ezt/t/w1BWQtq/weight.png

B Girl
on 6/5/07 12:16 am

RNY on 07/10/07

I have Aetna PPO in FL. My understanding is that all Aetna policies are subject to the same medical necessity guidelines provided they don't have an exclusion on their policy. Have you looked up their guidelines? I read and re-read their medical necessity requirements.