Great News for people insured by Aetna

[rroswelltx 1]

As of friday the 32st, the have changed there clinic policy and are now covering the band...WHAHOOOO. Hopefully now my appeal will go through with flying colors.....................

[Alexandra 55]

Is this an April Fools joke? Friday the 32st? :ban:

If this is true, it's AMAZING!! YAYAYAYAY!!!

[rroswelltx 1]

LOL, no april fools joke just a typo!!!

They really did change it, isn't that great!!!!!!!! It now shows the same requirements for RNY as lapband, no more pushing people to have RNY. Praise God!

[NeenBand 7]

Will they cover fills and things that arise? I'll be getting Aetna soon.

[rroswelltx 1]

Looks like it, but it may depend on your company too.

[CindyCam 1]

I have Aetna Managed Choice i live in louisiana and the doctors office just delt with my insurance and they denied so i will be cash pay...anyone know anything about Aetna Managed Choice?

[Ginib 0]

The Clinical Policy Bulletin is 0157 and states:

Aetna considers open or laparoscopic Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable silicone gastric banding (LASGB or Lap-Band) medically necessary when the selection criteria listed below are met.

There used to be something there for the band stating it will be covered only you were at an increased risk of adverse consequences of a RYGB. However, the new policy does not make that distinction for the band, only for vertical banded gastroplasty.

Also, there is now a CBT code for fills: S2083

There is further explaination that shows long term loss of 30-50% for bands and 50% for RYGB.

[shanzmac 0]

Yeah! I just met with Dr. Sonnastine yesterday and have been really concerned about Aetna, then I read this and I could do a flip( if I knew how and could get this body to flip)!:biggrin1:

[Lorraine S. 0]

I have not checked in to Aetna to see if they have changed their policy this year but do know very well that I have been denied for the last 1 1/2 years by them. I weigh more than my adult daughter and four grandchildren put together.

I have Aetna HMO please let me know of any secrets to get this procedure done.

[Alexandra 55]

Lorraine, the big question is why are they denying you? Their policy regarding banding has changed since you first applied for approval, so perhaps starting from scratch now would yield a better result.

If you tell us why, specifically, they denied you perhaps we can offer some better advice.

[haloep 0]

I talked with my doctors office last week, and they said that Aetna didn't cover, when did this all change, I so hope this is true? Thank you for your time. haloep

[Alexandra 55]

Haloep, your doctors can't know what YOUR policy covers and what it doesn't cover, so don't take a sweeping statement like that for truth. Yes, Aetna has historically been difficult, but now they have changed their standard criteria so many people will, I think, find it much easier to get approval for banding. This change only went into effect recently, so it's possible your doctors' office doesn't know about it yet.

But no matter what, don't let someone else tell you what is true for you and your plan. If you're up against an exclusion or aren't medically qualified for surgery you will have trouble no matter who the carrier is. If these barriers don't apply, then you may be in luck. What is your specific situation?

[DrHekier 0]

About 2 weeks ago I attended a Lap Band symposium and the change for Aetna was mentioned. Apparently it just took place a few weeks ago. My understanding is that Lap Band and Gastric Bypass are now on equal footing as far as Aetna is concerned. In the past Aetna had extra criteria required for patients who wanted to choose the Lap Band as opposed to the gastric bypass, and those extra criteria are no longer required.

Since this is a new development, your physician's office may not be aware of it.

Good luck!

[shanzmac 0]

Thank you for confirming that for us. it is greatly appreciated.

[DrHekier 0]

Here's the link to the clinical policy bulletin by Aetna, revised March 31, 2006:

http://www.aetna.com/cpb/data/CPBA0157.html