Aetna H.M.O

[TxCoon 9]

Can anyone tell me their requirement/approval process with Aetna Select or HMO? Thanks in advance

[Check22 5]

I'm going through process right now with Aetna HMO. It's a 3-4 month waiting period. From what I've been told and been reading on there website is you have to meet certain criteria, such as certain bmi or hypertension. The website explains it all. You cannot gain weight at your final weigh in. So whatever you weight was on first weigh in, don't show a weight gain on last one before doctor submits all paperwork to insurance for approval.

[TxCoon 9]

I just called Aetna and they said they do not cover it under my plan. I'm with Aetna select which is an H.M.O. They said I would need to wait until January and switch to a P.O.S. and then it would be covered. My dream is now shot.

[Check22 5]

I just called them 5 minutes ago to confirm and I was told it is 100% coverage with no deductible and no co-pay. You should call again and ask to speak to manager or someone else.

[TxCoon 9]

That's reassuring. I will definitely call again. Calling now. Fingers crossed!

[TxCoon 9]

I just called again and spoke with a supervisor. It is not covered. This stinks ????

[Jersrose43 837]

Is your plan through an employer ?

If yes the employer decides whether they will cover it or not. If you stay with the employer it is likely whatever policy he offers HMO Pos or indemnity- it won't be covered.

[TxCoon 9]

I wonder if this works.

[TxCoon 9]

Well I guess that's the end of it for me. Guess it's not meant for me to be healthy. I called the surgeons office and asked and they said if I don't have coverage, then they cannot bill it. God bless all of you. Thanks for all the info.

[Check22 5]

You could always ask if your employer offers another insurance policy from a different carrier and see what type of options you have with them. There is always out of pocket. Most places offer payment plans.

[Jersrose43 837]

Your doctor if he is willing and you qualify for a hernia surgery, could bill that and you pay the difference of the vsg

[TxCoon 9]

I don't have a hernia.

[Check22 5]

Not trying to be rude here but your giving up on your health this fast? This surgery is a tool not a miracle surgery. It requires just as much hard work as a person who doesn't get it done to lose weight. While your working on figuring out the coverage, continue or start to work out. Good luck pal.

[TxCoon 9]

First off, I know the hard work it takes. I'm not lazy in the least bit and I darn sure will work hard for what I want to try my best to succeed. But when your insurance doesn't cover it, there are no other options other than paying cash for it. Which is what I will have to do at this point. I did not want to pull from my savings, but it looks like I have no other choice. It's sad that insurances won't cover a procedure to help a person stay healthy.

[TxCoon 9]

And by the way, I have been in the gym 5-6 days per week for the past 3 years with little to no results. As soon as I had my hysterectomy, my body has suffered severe consequences and one of those is the inability to lose weight. I have not gained weight, I have maintained my current weight going on 4 years now.

Edited July 13, 2015 by Smj481