Question:
New Rules for Aetna

In light of the new rules established by Aetna as of 1/16/03, has anyone with a BMI under 40 been approved? I only have one co-morbidity. I have a family history of obesity, hypertension, diabetes and cancer. Aetna changes their policies and keeps narrowing criteria.    — Katerina M. (posted on February 19, 2003)

February 19, 2003
Hi, According to the way I read the policy (I also have Aetna), If you can show that you have had EITHER a BMI over 40 for the past 5 years OR a BMI of between 35-40 with ANY of the co-morbidities that they list (hypertension, type II diabetes, heart disease, severe obstructive sleep apnea), then you will meet that first criteria. Assuming that you're over 18 (criteria #2), then the only thing you have to worry about is meeting #3 - the dr. supervised diet with nutritionist counseling. I'm still working on #3. I would advise you to have your doctor refer you to a nutritionist if you haven't been to one in the past 2 years. You need to have 6 months of documented (I was told it did not have to be a continuous 6 months) dr. supervised dieting. You did not mention what your BMI or co-morbidity was. Was it one of the ones I mentioned?
   — Carolyn M.

February 21, 2003
I have Aetna US HEALTHCARE Mcn and these rules are what I had to go thru 2 yrs ago. I had to have 2 medically supervised diets,a minimum of 6 months each plan that was supervised by the Dr. and nutritionist. Some Aetna plans had different policies than others. I think they're trying to bring them all into line with one another. My BMI was exactly 40 with no co-morbids. I had a 12 yr history of obesity. I think (and I don't blame them) that they want to make sure that people who truly need and want this surgery get it. We all know some folks who have been MO for only a few years. In those 2 or 3 years they really haven't done much to make an effort to change.(don't get me wrong, some do try and struggle and some don't do anything and want an easy way out)(By easy I mean without the struggle of dieting/changing eating habits etc..)They are just trying to cover themselves with the numbers of folks who are wanting/needing this surgery. By making such stringent guidelines they are focusing on those who truly are MO and have struggled with losing and regaining. Literally everything they've tried dsn't work-But, they've been trying! Best wishes to all you as you begin this journey.
   — Linda M.