The dreaded word: Exclusion

[Zully Quirke 0]

Apparently, Aetna has the Lap Band surgery listed as an exclusion. While I sit over here and try to boggle over why a company would exclude surgery to eliminate morbid obesity, I turn to you all for help.

I have another insurance option -- my company's insurance is under Blue Cross/Blue Shield of Texas. Anyone have any positive experience with them?

That aside, is there ANYTHING you can do if they've listed it as an exclusion? Any kind of appeals process that's worth a hoot?

[Ragdolz 0]

Hi! I am looking for Aetna info for my sister, we both want the band, I'm self-pay and she is with Aetna. What I have found is the company Aetna does cover the surgery but it sounds like there is an exclusion on it for your particular plan. What you could do is go the search at the top, put in Aetna or Blue Cross, then if you want to narrow it down to posts (as opposed to whole threads) that only show when that company is mentioned, punch the box for show posts... that's how I found you! Good luck on your search!

Dotty

[anonemouse 1]

That aside, is there ANYTHING you can do if they've listed it as an exclusion? Any kind of appeals process that's worth a hoot?

From what I've heard, unless you can talk your company into dropping the exclusion, you probably won't have luck with appeals.

I have another insurance option -- my company's insurance is under Blue Cross/Blue Shield of Texas. Anyone have any positive experience with them?

I have a different insurance carrier. The first thing you should do, though, is check the benefits and make sure that your company hasn't put an exclusion in that policy, as well.

[Alexandra 55]

Laurend's right, Zully. "Exclusions" are usually the province of the employer, not the insurance carrier. If your employer excludes bariatric surgery on one of its policies, it's likely an across-the-board thing.

[katschai 0]

Hi - if there are exclusions as Alexandra said it is the employer who sets those conditions. if you have not read it, below is the link to the Aetna Policy Bulletin on obesity surgery.

http://www.aetna.com/cpb/medical/data/100_199/0157.html

But your employer can negotiate to exclude certain things. I guess your state does not have a state law about this. In Maryland obesity surgery cannot be denied maybe we are a unique state. Good Luck

[Lap_dancer 8]

Apparently, Aetna has the Lap Band surgery listed as an exclusion. While I sit over here and try to boggle over why a company would exclude surgery to eliminate morbid obesity, I turn to you all for help.

I have another insurance option -- my company's insurance is under Blue Cross/Blue Shield of Texas. Anyone have any positive experience with them?

That aside, is there ANYTHING you can do if they've listed it as an exclusion? Any kind of appeals process that's worth a hoot?

Blue Cross and Blue Shield of Florida has an exclusion on my plan. I can't understand it either. Are they that stupid? If BCBS of Texas is a go, and I would check, double check, and triple check the policy, then go for it. You want to look for the requirements for surgery approval. Some make you wait six months for a doctor supervised diet. If you have already had that don't worry. Just check.

[rico 0]

Maybe we should start a petition for those in Florida to our state insurance commissioner to have this covered and to force these employers to pick up riders or cover it for those of us that need it medically. If anyone is interested on petition ideas or letter ideas write me reyes1178@earthlink.com I am tired of this not being taken seriously. Maybe if enough voices are heard something will be done. My husband works for Walmart and they totally excluded these surgeries because they just don't care or want to fork out money. Let's get it started right here don't wait these are our lives that our being played with. I want to live past 28 to see my four boys grow up!!!!!!!!!!