Can they really say it's not a co-morbidity?

I was diagnosed with Sleep Apnea a few months ago. I have always had HBP. My BMI did not get to 40 and above until late 2003.  My Insurance company (Aetna ) has denied me yet again for "BMI not over 40 for a consecutive of 5 years and/or BMI not over 35 for a consecutive of 5 years with comorbidities" Aetna doesn't count my HBP as a co-morb because "it's treatable with medication". Yes, im serious! My question is: does my Sleep Apnea only count from the date that I was officially diagnosed? Or, can I also list it as a co-morb during the time my BMI was below 40? Thanks for any help clarifying this,  Cathie

Thanks Paul, I hadn't thought about that. You are so insightful. An asset to OH!

Been there. Doing that. I can quote the CPB in my sleep!  The problem has not so much been with Aetna but with my employer as I have a self funded plan and my employer has handled both of my appeals. Im also finding out that our "benefit analyst" doesn't know much about a.) our company Summary Plan Description, b.) Aetna's CPB regarding Obesity Surgery.  Ultimately, i'll probably have to retain an attorney for my next appeal.  Cathie

Cathy, I wouldn't waste time arguing with them.  I would go straight to the internet, and search insurance commission for your state (GA?).  On the insurance commission web site, there will be a place to put in your personal insurance information, and a space to write a note.  Tell them what you are telling us, and request to open a complaint.   I did this after fighting just the same problems you are fighting for about 4 months, and repeated denials.  My insurance co. contacted ME, and told me that THEY were going to re-submit for me...2 days later I was approved.!  (I had given up, by the time that I put in a complaint with the insurance commission. )  The insurance commission will simply tell your company that a complaint has been filed.  IF your co. doesn't settle the dispute with you, then you will have to provide documentation to the commission for further review, but trust me, insurance companies DO NOT want to tangle with the Insurance commission.  They will take a very close look at your request, and approve it if at all possible, BEFORE you go that route!  Good luck! Robyn 

Robyn,  Thanks again! I checked out Ga.'s site and it really is as easy as putting in some information and writing a note. I wonder though, can you make a complaint through the Insurance commission if your plan is self funded? Would I file a complaint on Aetna or my employer (who handels my appeals)?  I appreciate the encouragement,  Cathie

My insurance is self-funded as well.  The insurance commission has no authority over self-funded plans, but when the insurance company saw that there was a complaint out against them, they quickly responded, before that issue could be sorted out!  The insurance commission came back to me after about 2 weeks and told me that they could have no authority over my plan, but, by that time, the insurance company had approved me!   It is worth a try... Good luck! My husband and I both had surgery on the 31st of December.  His insurance was changing to United health care as of the 1st of Jan.  He had some bleeding issues, and had to stay in the hospital until yesterday.  I have had none so far.   Went shopping for my 4 kids yesterday, did dinner, cleaned house with them, picked him up from the hospital, etc.   Just have to move slow and sip, sip, sip.  I find that popsicles are a great mobile form of liquid.  It really felt good to eat a popsicle while shopping...didn't see as much that I wanted to eat!   Wimpy Men...LOL!

Thank you so much for the advice. And, WOW! surgery 6 days ago and life is (somewhat) back to normal. I hope you both continue to do well and have great success!  I WILL join you on the losing side one day .... Cathie