Aetna covers Lapband?

[MaggieB 6]

Thanks everyone for the great info. Does anyone regret having the lapband? What are the biggest obstacles to overcome once you have it.

No regrets. The head hunger part has been difficult - just old bad habits are hard to break but as this last year has progressed it is becoming easier for me.

[cunner 21]

Every plan is a little different. I had a BMI of about 38.5 as well as High BP, high cholesterol, GERD, and sleep apnea and several years of documented history of BMI over 35. I was denied by Aetna and lost both appeals. The final step is appealing to independent external review. This is where I was approved and Aetna was forced to pay. It took an entire year of fighting and was extremely stressful but it was so worth it in the end. I had my surgery on Dec 28th and I am down 70 #s and only 20 #s left to go the get to my goal. My BP and cholesterol level are now normal and GERD and sleep apnea are gone.

If you do run into issues with your approval I highly recommend Walter and Kelley Lindstrom with obesitylaw.com.

They were so helpful with the appeal process and it cost me nothing to get their help. I just can't say enough about Kelley and how good she was throughout the process. Good Luck and don't take no for an answer. Keep fighting it until you get approved.,

[DaddyD 1]

I have Aetna through my wife's job, and while Aetna DOES cover it, I had a heck of a time getting approved, because at the last minute (3 weeks before surgery, after completing a 3-month program with all the bells and whistles), contrary to everything we'd been told, I get a call that Aetna has denied me because my wife's employer put an exclusion for weight-loss surgery in their plan. I was devastated and angry. But it turned out that there just was a wording difference between the plan the company actually had, and the plan that Aetna thought they had. Yes, there was, according to the company, a general exclusion, but it would be waved if you could prove "medical necessity". But Aetna didn't have that part in their records. So, we were told they'd fix the error, but it would take a couple of weeks (!!!???). Okay. So a couple of weeks later we re-submit, and now they say "Okay, so we DO cover this, but we need to see weight records from the past two years from your doctor." I'm like, WHAT. I hadn't seen a doctor that weighed me since 2006. I managed to get THAT record, and praise the Lord they took it as fulfilling the requirement.

I got official approval literally on the Friday before my scheduled Tuesday surgery. Which was, I was THEN told, too close, because the hospital needed me to come in for pre-admission testing first. Did that, and now my surgery is set for this coming Tuesday.

So, long story short, yes, Aetna covers it, but make sure you know all the details.