Yo Yo Weight History

MadlyInLovewithChees
e

on 8/9/13 1:41 am
VSG on 11/25/13 with

So I have Aetna for my insurance and one of their pre-requisites for authorization is that you provide a BMI of over 40 or co-morbidities and a BMI of over 35 that has "persisted for at least the last 2 years (24 months), documented in contemporaneous clinical records". 

I just requested that my doc fax over my weight history to my surgeon's office, but I am not 100% sure that every year at my annual physical I had a BMI of over 40 because I, as so many of us have in the past, yo-yoed dramatically in weight with fad diets.  That being said, I definitely had a BMI of over 40 well over 2 years ago.

I'm pre-emptively freaking out over this.  Have any of you had approvals (hopefully with Aetna), where your weight history showed you yo-yoing below and above a BMI of 40?

        
MadlyInLovewithChees
e

on 8/9/13 1:49 am
VSG on 11/25/13 with

maybe i can just submit the documentation for the years where my BMI was over 40....oh man, i'm like having a panic attack over here. i don't want this all to come crashing down.

VSG on 06/12/13
Submit what meets the criteria, and not what does not. If you happen to be denied, this part is fight able. Please don't freak out!

   

Sleeved 6/12/13 - 100 pounds lost to get to goal!

Jackie T.
on 8/9/13 1:53 am - KS
VSG on 12/19/12

Do you have any co-morbidities?  High blood pressure, high cholesterol, sleep apnea?  That would make a difference.  If really concerned, you might talk to the insurance person in the surgeon's office and they can tell you what their experience has been and how your information my relate to the process.

Hang in there!

Highest Weight: 285 SW: 264.6 CW:163.1   Surgeon's GW: 189  PCP's GW: 165-170  

My GW:  154   MFP:  jteaford                  

        

MadlyInLovewithChees
e

on 8/9/13 1:56 am
VSG on 11/25/13 with

I have slightly high cholesterol, but I don't think that is considered a comorbidity by aetna.  i am getting tested for sleep apea in a couple weeks- and my husband swears i have it, so that would solve everything, but i don't know if having it diagnosed now is sufficient, or if i also had to have that diagnosed 2 years ago....

sometimes this process can be so stressful. 

MadlyInLovewithChees
e

on 8/9/13 2:49 am
VSG on 11/25/13 with

Disclaimer:  I know I must sound like a crazy person, sorry.  There is just so much that goes into this process and I would be devastated to lose it all now.  I definitely am over 40 now, and I definitely was 5 years ago, so hopefully that is sufficient, regardless if I went down in between.  Their wording is so confusing and no one at Aetna will give you a straight answer. 

Jackie T.
on 8/9/13 3:33 am - KS
VSG on 12/19/12

Your not crazy!  A lot of this is confusing and each plan is just a little different.  The reason I had asked was that sometimes if you have co-morbidities they lower the BMI requirement. I wish you well and hopefully you will breeze through the process.

Highest Weight: 285 SW: 264.6 CW:163.1   Surgeon's GW: 189  PCP's GW: 165-170  

My GW:  154   MFP:  jteaford                  

        

MadlyInLovewithChees
e

on 8/9/13 3:37 am
VSG on 11/25/13 with

ty!

Lauren Vento
on 8/9/13 3:11 am - Lake Elsinore, CA
VSG on 09/08/12

I don't think you need a 40+ BMI for over 2 years to qualify, I think thats just with the 35+BMI, but that is my guess.  Best of luck!  I hope it goes smoothly and quickly for you!

Certified Life Coach & WLS Support Coach

  

G5x5
on 8/9/13 3:15 am - VA

There is nothing wrong with editing out points in time that don't meet the criteria.  You are not required to give them full disclosure, you only need to provide the specific items needed.  i.e. Documents that support the weight across points coverings two years proving this is a long term problem.

While they ask for a two year history, they aren't expecting you've had regular monthly weigh-ins across two years so they can dig in and inspect all of that.  You only need your physician's confirmation that will prove the condition exists across the required time period.  Usually they only need the exact physician notes for a shorter period of time, like six months.  So you shouldn't have to worry about visits going back two years where things might have been more favorable weight wise.

Just make sure your physician's documentation doesn't run together and give too much data.  If necessary, by working with their office you might be able to get things to print out in a way that presents your case in the best light.  However, be prepared to do some leg work, not all physician office staff is err... well let's say it nicely "up to the task".  You might have to be slightly pesky (and speak slowly if you catch my drift).

HW: 255 (6/5/13), SW: 240 (6/19/13), CW: 169 (9/16/14)

M1: -26,  M2: -17,  M3: -5,  M4: -13  M5: -12  M6: -11  M7: -8

M8-10: Skinny Maintenance (10k Training)   M11-13: On Break

M14+: **CROSSTRAINING FOR ALL AROUND FITNESS**

Google NSNG and learn the right way to eat each day

Most Active
×