Aetna "weight history" question

[SandraVA30]

Ok, here is my dilemma - I am in the process of completing the 3 month multi program that Aetna requires. Part of their requirement is having a BMI over 40 (or 35 with co-morbities which I don't have) for the previous 2 years. My BMI is currently 47. Ok, so this is where it gets kind of tricky for me. I originally was going to start this process at the end of last year but was afraid they wouldn't approve me due to my BMI in 2006. I am a yo-yo dieter and in 2006 ONLY I had a normal BMI. Every other year it has been over 40. (That whole thing irritates me, I think they should look at OVERALL history, not just 2 years) Anyway...so now it's 2009 and I will be submitting for pre-approval at the beginning of March probably. Do you think submitting my weight history for 2007 and 2008 will be ok or do you think they will ask for 2006? And do the specific dates in 2007 and 2008 matter or just anytime during the year. I am just not sure how picky they are. If they ask for 2006 I am pretty much screwed. And what exactly do they want with "weight history" in terms of documents? The insurance coordinator at my surgeon's office says they just need a date and weight on letterhead from the doctor, not my entire medical records. In your experience, is that enough? I guess if worse comes to worse I will have to wait longer to submit for approval, but since it's 2009, I am thinking that technically they won't ask for 2006. Any thoughts/suggestions?

[JDru]

I have Aetna too and I had to submit records for 5 years prior. My weight had also gone up and down over those years, but overall I would have been considered obese. Was your BMI under 35-40 before 2006 as well?

[SandraVA30]

Prior to 2006, it was above 40. If they ask for 2006, do you think I should just say I didn't go to the Dr. in 2006 and then provide 2004 and 2005 or provide it all and just hope they don't get nasty about it? :)

[JDru]

I would say if the requirement is only 2 years, then only submit for 2007 and 2008. Your BMI was high enough during these years and it'a all they're asking you to submit. But if they do ask for more documentation, provide the older years where your BMI was over 40 and see if that works. I hate dealing with insurance companies!

[little t]

In my experience, my surgeon wanted me to have the surgery done, so they did everything they could do see that I was approved. I am sure your doctor will submit 2007-2008 and you will be fine. Don't wait any longer!

[Neal R.]

I agree with Tami, these Dr's know how to work the insurance companies. THey will do their best to show that you need it.

[Kim G]

I work for a bariatric surgeon and I do the insurance pre-cert Aetna wants a 24 month weight history...so we are now submitting anything from 2007 & 2008 (but for 08 it was to be at least Jan or Feb of 08) It's like they want the closest weight to be at least 1 yr from the current day and the oldest weight (2007) they normally don't care when it is. So I personally think you will be fine! :) Just my 2 cents!

[CorporateMike]

I am having this hang up as well. I keep hearing from the clinic that they need five years, but I have a hand out that they gave me saying that it is two years. I have Aetna as well.

Help! Please? LOL.