Aetna - Getting approval with limited medical history

I'm new, I'm just starting the WLS journey and trying to get all my ducks in a row to hopefully eventually get approved. I have Aetna PPO and Aetna just recently added a requirement to have 5 years of history proving morbid obesity/40+ BMI. Problem is, I'm one of those people who only goes to the doctor when she's knocking on death's door... the last time I saw my PCP was just under 3 years ago. Another problem is that I'm only 21, and while I'm 99% sure that I was over a 40 BMI five years ago, I don't know for sure (I am fairly sure I went for a vaccination around that time, or something for school, though, and I'm hoping they recorded my weight!) I know I was also weighed at school around the same time, it was a yearly thing. Despite not seeing my PCP for so long, I have had three kids between then and now (there's twins in there - I know three kids in three years is a lot!)  and my weight is recorded in my charts between June 2004 and February 2007, all well over the 40 BMI requirement - and I'm fairly sure that if it were acceptable, he'd write a letter of recommendation. I also can get records from several ER visits in that time period that state my weight. Is it possible to use these things to get approval or does it have to be from a PCP? I was pretty pumped about this for a while, but now that I read and re-read Aetna's clinical policy bulletins, it's looking like my chances of getting approved are getting smaller and smaller :( Thanks in advance for any advice/tips and I am sorry if this is a stupid/frequently asked question.

Melissa,  Have you tried calling Aetna and speaking with a rep.? Cathie

garhter everything you can and provide it to them. everything>

I don't think it has to be your PCP, just medical. Try to find anything you can. Were the school weigh-ins done by the nurse? Did you have a well-woman checkup after starting menstruation? Is it possible that even a dentist or other professional you might have seen took baseline health measurements?

I was approved by Aetna.  The records can be from any medical provider not just your PCP.  I used records from my PCP, the Gyn and the local walk in.  Like you, I never went to the Dr unless I was dying!  Good luck with your journey.  Aetna can be a real pain in the tush! 

I am an Aetna expert! I've battled them for 14 months (don't get discouraged, this was an effect of my own situation). You can get approved as I have done. I was denied in the beginning of 1/08, and I now have an approved surgery on 2/11. Remember, the squeaky wheel gets the grease. You have to be prepared to call and harass them daily...I did, and I get my life back on 2/11. You should remind yourself that your children get their lives back on the day your surgery is approved. You should get medical copies of the notes from each of their births, that's 3 years. Your obstetrician should have more notes. Anyhow...here's the deal...Aetna requires 3 things. 1. proof that you've been obese for the last five years. 2. existence of co-morbidities. If you have elevated blood pressure, this should work. Anything else is just window dressing. 3. either a 6 month physcian DOCUMENTED and monitored weight and nutrition program (this is where you and your doc met once a month to review your progress) or a 3 month multi-surgical disciplinary regiment (this is where your doc refers your to an exercise therapist and a dietician and you meet weekly for 3 months). The latter is what I chose, and it worked out for me. I was approved the very first time I submitted the office notes for the latter. The true key is staying on top of your medical providers to ensure they write what you need in your notes....if you don't stay on top of them, they often will not. Good luck and best wishes.....Montanapatient!