VSG and Aetna Choice POS II Insurance

[lovinlora78 1]

I am only in the research stages of possibly trying to get the VSG in maybe the early months of 2016. Has one ever been approved with using Aetna Choice POS II? I think it is a PPO plan. Honestly, not sure. I have heard that most insurance companies will normally only cover the Gastric Bypass and the Lap Band and I have no interest in either of those procedures. I am only 4ft 10 and about 215 lbs with high blood pressure & a mild fatty liver. I am sure I am a candidate but I can't afford it being a single Mom of 3 with not so good credit.

[reclaimingmyinnerbamf 11]

Hey There, I have this plan!

My gastric sleeve surgery is scheduled for Tuesday, March 24th!

This is what I had to do:

Mandatory for All Patients

• Cardiac Clearance
• Pulmonary Clearance
• Mental Health Clearance
• 
  Dietary Evaluation
• sleep Study
• Endoscopy
• Endocrine Consult Required

Insurance Required

• 
  2 Year Weight History (Required for all Aetna Patients)
• 
  4 month weight loss program

Required by Surgeon

• CPAP titration results
• Endocrine Labs Only Required (TSH, HgbA1C)
• Gallbladder Ultrasound Required

If you have any questions, please reach out to me.

Good luck on your journey!

[lovinlora78 1]

Thanks so much for your reply & all the information provided..Were you out of pocket a lot?

Hey There, I have this plan!

My gastric sleeve surgery is scheduled for Tuesday, March 24th!

This is what I had to do:

Mandatory for All Patients

• Cardiac Clearance
• Pulmonary Clearance
• Mental Health Clearance
• 
  Dietary Evaluation
• sleep Study
• Endoscopy
• Endocrine Consult Required

Insurance Required

• 
  2 Year Weight History (Required for all Aetna Patients)
• 
  4 month weight loss program

Required by Surgeon

• CPAP titration results
• Endocrine Labs Only Required (TSH, HgbA1C)
• Gallbladder Ultrasound Required

If you have any questions, please reach out to me.

Good luck on your journey!

[reclaimingmyinnerbamf 11]

So far, I haven't gotten the bill but I heard 80/20. We shall see. I hope its not crazy.

[majorsmama 91]

My plan is Aetna Choice II (my card says nothing about POS). I'm not sure how it differs. But here is the bulletin from Aetna regarding bariatric surgery:

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

I am required to do exactly what it states in that bulletin. My BMI is over 40 so I don't need to show co-morbidities. I did have to do a psych eval and I will have an endoscopy but that's more for the surgeon than the insurance company. I didn't have to do all the labs or sleep study and all that.

Edited March 19, 2015 by majorsmama

[majorsmama 91]

Oh and as for cost, your insurance will have a max out of pocket that you are required to pay. For example, my plan is 80/20 but my max out of pocket is $2000 so I shouldn't have to pay more than that. So far I have paid my $500 deductible at my initial consultation and then have paid a $27 co-pay at each visit with the nutritionist.

[Invictus 56]

On the required 4 month weight loss program, was that between initial inquiry and surgery, or just proof of weight loss program of that length?

[reclaimingmyinnerbamf 11]

On the required 4 month weight loss program, was that between initial inquiry and surgery, or just proof of weight loss program of that length?

I had to do a 4 month medically supervised weight loss program. I did: December 2014, January 2015, February 2015 and March 2015. It goes by quick especially while you have to get all the other prerequisites done.

[majorsmama 91]

Was your December 2014 visit the initial consultation? or a separate appt?

[reclaimingmyinnerbamf 11]

Was your December 2014 visit the initial consultation? or a separate appt?

Initial Consultation and Weigh in

[majorsmama 91]

Was your December 2014 visit the initial consultation? or a separate appt?

Initial Consultation and Weigh in

This is very helpful! My surgeons office is trying to tell me that the initial consult and weigh-in doesn't count as the first appt, however Aetna told me that it absolutely does. So it's nice to hear from someone who has been through it who used the initial consult as the start of the 90 days.

[reclaimingmyinnerbamf 11]

Your doctor is trying to milk you and the insurance company.

[majorsmama 91]

Your doctor is trying to milk you and the insurance company.

I kinda figured but I have posted this question here before and several Aetna policy holders said the same thing my surgeons office said. So it's either a common misconception that people don't bother to research... or many surgeons are milking people in this same way.