Recent Posts
Jen
Hi Jen11014,
I had my RNy through AETNA. I had to do the 6 month medically supervised diet, and all other requirements. The surgeon, nutritionist x1, and psych x1. was what I had to do over 6months. I would phone and inquire about the 3 month protocol.
Wishing you the best,
Rose RN
PS. see you on the other side!
I have Aetna (HMO not PPO) and it's been a 14 month journey. Orientation, 6 months of weekly nutrition classes with weigh-ins, food and exercise diaries and a mandatory 10% body weight loss requirement, back to PCP for another referral for the pre-bari program, waited 3 mos for approval, then 2 months of weekly pre-bariatric education program with weigh-ins and diaries again, psych evaluation, back to my PCP for a surgical referral, then wait for approval and appointment to consult w/ the surgeon. That's where I am now. The surgeon will tell me what pre-surgery tests he wants, wait for approvals, then VSG surgery hopefully in September/October (month 16). BMI started at 52 and now I'm at 43 and have to maintain or I'm cut from the program.
But, hey, at least they cover it!!!
MrsEveland
Highest weight: 304 Surgery weight: 242 Goal weight: 140
thanks for your help Laurie!
I found a missing weight from 2011 where my bmi was 40.6! They require that your morbid obesity must have persisted for the last 24 months. Basically, you need to have given up losing weight over the last 2 years. I think I'm good to go! Just had to rack my brain to figure out which doctors I saw that year.
My individual contract required a BMI of 40 with no mention of comorbidities, period. Plus, it required a 5 year history of morbid obesity. And, that is what "won" when it came to deciding my preauthorization approval.
Hopefully this illustrates the importance of getting your contract vs a clinical bulletin. MAKE SURE this comes from your employer/the organization that you pay for your healthcare.
Laurie
Sleeved 6/12/13 - 100 pounds lost to get to goal!
Good luck!
Laurie
Sleeved 6/12/13 - 100 pounds lost to get to goal!
I'm not entirely clear - are you required to show history of morbid obesity, or history of failed weight loss attempts? It seems like it might be the second, and if this is the case, you may be ok, depending on the timeframe they want to see. If it is a history of morbid obesity (this was a requirement I had in my UHC claim), I pulled pages from various points in time. Don't forget to get records from places like urgent cares and your GYN if they help support your case.
Just make sure your medical chart clearly shows the ups and downs in the correct timeframe. And, based on what I have read from others, a BMI of 43 should be enough to qualify.
But, as I put in my original post, be sure to get a copy of your contract so you know specifically what you have to show.
Good luck!
Laurie
Sleeved 6/12/13 - 100 pounds lost to get to goal!
Maybe they just like to submit more information to show a pattern...
Preop: -10; Mo 1: -21 Mo 2: -11 Mo 3: -10 Mo 4: -15 Mo 5: -10 (Onederland 2/19/14!!!) Mo 6: -11 Mo 7: -8 Mo 8 : -9 (100 pounds lost 5/13/14!!!) Month 9: -5 Month 10: -5 (Goal 7/14/14) CW:157.8 (-2.2# BELOW GOAL)
Just curious if any of you have Blue Cross Blue Shield of Mass, and if so, about how long did it take to get approval from them? My surgeon would like to do my surgery in September but I'm still waiting approval.....
Thanks!
Hockeymom87 · 0 replies · 858 views
