Aetna Open Access Vs. United Healthcare

[Olive 0]

Hi,

Can anyone comment on their experience with these two companies? I just started a new job and have a choice.

I wonder which would pay for fills or revisions in case of a complication.

Thanks for any input!

Olive

[rajgrover 0]

Aetna will not cover lapband or fills, etc. I had both and currently have UHC. Actually I had Aetna Open Access thru my work and UHC thru my wife. My surgery was canceled one day before the surgery as they considered Aetna as Primary and UHC secondary... and the hospital said that Aetna will not pay a penny towards the lapband, and as UHC was secondary it would not kick in if Aetna paid zero. So later that year I dropped my Aetna coverage and had the lapband put in under UHC. They cover everything, including fills. Stick with UHC .... stay away from Aetna!

[JJB 2]

I have United Health Care. They paid for my surgery. But they will not pay for fills. My Dr. includes all your fills for the first year. I am trying to get my band adjusted just right so I wont have to pay for any. But I thought UHC was great and worked really fast for me. Good luck.

[CTpaddler 0]

Not all group health policies from a particular insurance carrier are the same. Each insurance carrier may have many versions available and each employer will select the version it wants to provide. The coverage provided by Employer A may not be the same as the coverage provided by Employer B even if they use the same insurance company. You need to get the specifics of the policy in question.

For example, I also have UHC, and not only did they cover the band, they are covering the fills (with co-pay). (Yippee!!!)

I'd recommend you get a copy of the policy, and, as painful as it sounds, read it carefully. Then call or write the company and ask questions. That's really the only way to know exactly what they will and won't cover.

Good luck

Ellen

[ANewMichelle 0]

I have Aetna. My biggest fear through this whole process is insurance acceptance. I did see on my doctors website, that Aetna subscribers have had Gastric bypass, but much fewer lapbands by far. Though in Aetnas documentation it does include lapband. It is my last hoop to jump through, so I really have to hang onto the hope that Aetna will cover it. Are there any Aetna lapbanders out there?? Please respond. I'd like some support on this.

Michelle

Denver, Colo.

Rose Medical Center

[Mariezy 0]

I also have Aetna and I live in MA. My surgeon's office sent the request in 3 weeks ago and I am still waiting. I want the band and not the bypass but I fear that Aetna will not cover it. How long ago did you request it?

[ANewMichelle 0]

Mine will be sent in, in about two weeks. Still need some completed test results to be documented. CTPaddler's post had a very good point. Coverages are very different and even though they are A, different policies carry different coverages. Ours is A of MA as well. As a team, we followed their policy requirements to the letter. Documenting everything, even doctors office conversations. Weekly diet plans and excersize routines were copied into the doctors consultation notes. Test results, weight taken/documented every four weeks for six months, failures and accomplishments. My surgeon holds a seminar that explains all of the band procedure and a packet that helps to understand what your particular insurance requires. I hope your wait is not much longer and you get a positive reply. But even if you don't, their are still options available.

Appeal, appeal, appeal.

I'm not sure why the Ins. companies would approve more RNY than lapband. Anybody have a thought on that? A, has approved many RNY's on my Doc's Ins. list. What benefit would the Ins. companies gain from one and not the other?

[Janieh123 0]

Hi,

I had Aetna thru UPS and they paid almost 100% of the surgery and they pay 80/20 of my fills and 100% of the complications so far which consisted of getting plugged and making a trip to the ER and having my port flipped.

I will say it was a fight to get pre-approved but it has been great ever since. Don't give up.

Mary

[Janieh123 0]

Aetna paid well for me for the lapband. However I was told three times by a Aetna rep that they do NOT cover lapband. I appealed it and it took 9 mos but I won. I had lapband suregery on January 17, 2005 thru Aetna and they paid very very well. The whole surgery cost me less then $150 and they pay 80/20 on the fills. I think it depends who you have Aetna insurance thru if they pay or don't. The bottom line is FIGHT these insurance companies. After all you pay the premiums they need to pay their part. DON'T GIVE UP!!

[Smittyjulesberg 0]

It really depends on the employer. They determine what will be covered. I have UHC, and they do not cover anything. I'm going to appeal the denial, once I receive it and I plan on doing a self pay. The worst they can say is "no" so I'm gonna go for it.

[badmadmama 0]

United Health Care approved me so quickly, I was shocked. My BMI was not that high (5'10", 243 pounds) but I have intermittent high blood pressure, high cholestrol, GERD, use a machine for sleep apnea, am on two different antidepressants and am undergoing disc decompression for a deteriorated disc in my spine. I also got a stress fracture in my foot last year when I started a walking program. I never really felt unhealthy, but when you added up everything that I was being treated for....

[fosterc 0]

I live in Texas and Have Aetna, They only paid 50 % and will pay for fills after copay. It took me 18 months to get it, but during that time my policy changed and covered bariactric at 50 %.

[dpingl 0]

I have UHC, not a problem at least getting my approval letter. BADMADMAMA your situation sounds very simlar to mine. I have a BMI of 39, BUT I have asmtha, GERD and some arthritis plus border line HBP. I have also had 3 stress fractures in the last 2 years along with Plantar Facititis?? OUch. I would have not considered myself in POOR health just on the edge. With the weight, exercise was becoming harder and harder because I had constant injuries! I am grateful that UHC can see in the long this will SAVE them $$$!

[badmadmama 0]

Meee too! I have spent the last couple years taking care of everyone else, and lost track of ME. My husband, who is 7 years younger than I am, developed brain cancer a few years ago with a million life-threatening complications. We have two teenage daughters, adopted from Russia, and the older one freaked out and started huge behavioral problems when my husband got sick. The younger one has had six major surgeries, and five body casts, because of having polio as a baby. My dad developed a rare autoimmune disease and died while he was taking care of my mother, who had Alzheimer's disease. I ended up having to go back to work full time a year ago (my husband will never work again), and it was a shock how much younger and fitter everyone else was. Everything is more or less on an even keel right now (no hospitals or police), so it is finally my time to take care of myself again. Yesterday I got a manicure and a pedicure, and today I took a nice long nap.... and ate that last cupcake. No more cupcakes in this house, they are like heroin to me!!!!!

[dpingl 0]

It sounds like you have been taking care of EVERYONE! Wow, has stressful and unselfish of you. I love pedicures and AFTERNOON naps. Had my wisdom teeth out Friday and I seem to be getting headaches. Think I am going to stay home from work the rest of the day and take one of the naps myself. I had my psyc appt this morning, FRUSTRATED, because I have to go back a couple times because of my additctions to coffee and soda. ( I should I have lied.. HA but I probably need the support) I like to live life and I told him that, I think that was a behavioral concern.... Are you banded yet?