Question:
Has anyone been approved by Aetna without Dr records that verify 5 yr Obesity?
The Aetna CPB# 0157 states "Presence of morbid obesity that has persisted for at least 5 years" I did not go to the DR until a year ago. I have the 6 mths Dr. supervised diet, but not 5 years of Dr's records. I was thinking of providing pictures for the last 5 yers with weights and BMI. They even show my children growing up. Thoughts? — Tom Barton (posted on July 21, 2003)
July 21, 2003
Get the records anyway possible. I had records from 97,98,99,and 2001 and
02.. but I was lacking 2000. They waited to approve until I gave them
2000.. even thoough I had MONTHLY weigh ins (from OB appointments) for all
of the years I provided. I thought it ridiculous, but that's the way it is.
Call every doctor you have ever been to, even if it was just for a cold.
Aetna is easy to get approved by, as long as EVERY T is crossed and all I's
are dotted. Good luck.. Sarah... open RNY 2/3/03.. -109 lbs
— SarahC
July 21, 2003
Sarah -
That is the problem. I didn't go to any doctors until last year - so there
are no records. HELP! Ideas?
— Tom Barton
July 21, 2003
I guess I was one of the lucky ones. I have Aetna HMO and all I had to get
was a letter from my PCP and they asked for verification of a 6 month
diet.. which I only had 2 months worth. I did attend a doctor surpervised
diet center for a year but they are no longer in business so I was unable
to get any records from them. I told them all this in a letter that I
attached with the records. 6 weeks later I received an approval. My BMI was
39.7 (now it is 41) with no co-morbities.. Someone above is blessing me
from all the post that I have been reading. Good luck!
— Sixftmommy
July 23, 2003
Tom: I just got approved by Aetna yesterday without much hassle at all.
BMI 54, 460 lbs, 6'4", diabetes, cardiomyeopathy and sleep apnea.
Very little Dr. diet documentation, no exercise documentation to provide.
You don't mention if you have comorbidities; I think this is a huge factor.
Don't give up; IT CAN BE DONE IF YOU'RE PERSISTANT.
— duane B.
July 23, 2003
Hey Tom, I am so sorry to hear about your situation. I had absolutely NO
PROBLEMS getting approved through Aetna. I did not have to provide them
with ANY diet history, all they did was look at my medical record and saw
how many times I had been in the hospital as a type II diabetic with blood
sugar of almost 600 (no this is not a typo) I said 600. They approved me
within hours. I think something changed beginning Jan 2003 where there are
some new guidelines they are going by. I am so glad I had my surgery before
Jan 2003. My doctor has even put in my medical record, "no longer a
diabetic" my blood sugars are consistantly between 68 and 91. I have
lost 130 lbs and will be trying to get approved for a tummy tuck (through
Aetna) but this Aetna is an HMO and not a PPO, I changed jobs and don't
have the same Aetna policy anymore I had a PPO policy when I had my WLS.
Look at me just goin on and on.........Read my profile and if you have any
questions just drop me and email. Good luck!!!!
— gloriafb
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