Aetna frustration

jerseygirl · January 15, 2010

I've been reading about Aetna and whether they cover the sleeve or not. My PA hospital got a bypass approved, but what I really want is the sleeve. Aetna told them they won't cover sleeve unless it's the patient has had a transplant (like a kidney.) I know it now has it's own code and there's more research, but wondering if anyone has tried to get it to a review board or something like that. I hear that case managers are good to talk to also. I just don't want to call until I know what to say. Any input on this would be appreciated.

mmcclure · January 25, 2010

I, too, have Aetna and was told that they don't cover the sleeve. However, I did some research and discovered that their bariatric surgery guidelines are supposed to be reviewed on February 11, 2010. So, keep your fingers crossed that they will come to their senses and start covering it! Geez - less risk, better results, you would think it would be a no-brainer!

mrlddst · January 26, 2010

I went to the doc last week and they(his insurance team) think that Aetna will come around this year. So I'm supposed to go back in April.....I'm a little pessimistic so I'm not going to hold my breath.

mmcclure · January 26, 2010

I went to the doc last week and they(his insurance team) think that Aetna will come around this year. So I'm supposed to go back in April.....I'm a little pessimistic so I'm not going to hold my breath.

I'll make sure to find out after February 11th and post it here. I think they only look at changes once a year, but I could be wrong.

WingRider · January 26, 2010

I also have Aetna, and I also have the worst luck in the world, so with that being said since I just got my sleeve done in Mexico because I couldn't afford it here in the US I am sure Aetna will start covering soon. Granted I have nothing to prove this, just my speculation. I was approved for the lap band and gastric bypass, but no evil experimental VSG.

Good luck and keep working towards your goal.

Bill