I am new to the forum and just beginning my journey towards WLS. I just found out my husband's insurance (Aetna Choice Pos II) covers the procedure and will switch to his provider at the end of the year. I have already selected my doctor and they have begun the process of meeting all the requirments for the Aetna insurance plan. Once I switch providers they will submit the paperwork for approval. I sent an email to Aetna asking them about the coverage. Below is the response from the insurance company.
I have two questions if anyone is familiar and can offer answers:
1. Does this mean I will only pay a maximum of $5,750.00 before the deductable?
2. Is the maximum including doctor and hospital fees?
I plan on also sending my questions to Aetna too. I've enjoyed so many of your inspiring stories and look forward to posting on my success.
Thanks!
This is in response to your inquiry on your coverage for weight loss
surgery.
Your benefits
Your plan includes coverage for in-network and out-of-network services.
In-network benefits apply:
* Your deductible is $750.00 per calendar year.
* When your deductible has been met, the plan will pay 50% of the
allowed charges.
* Your plan has an out-of-pocket maximum of $5,750.00 per calendar year.
* Your plan will cover up to a lifetime maximum of $10,000.00 for this
procedure.
* Bariatric surgery is not covered if you will use an out of network
provider.
Your plan also covers obesity preventive counseling at 100% of the
contracted rate, no deductible, and no copayment for in network
providers. You are entitled to have 26 visits per 12 months, of which up
to 10 visits may be used for healthy diet counseling.
The information provided above is not a guarantee of coverage. Coverage
is based on all the terms and conditions of your plan as well as
eligibility at the time services are received.