BCBS vs. AETNA

[MizzouFan1 88]

Has anyone delt with aetna insurance? Are there general requirements before a person can be approved? What about BCBS- anyone had any trouble with them?

[faithmd 14]

Hi Sarah, you might want to check out the Insurance forum here.

Also, your policy may or may not have a weight loss surgery rider and the requirements may be different. The very best thing to do is get out your insurance cards and call each company and ask if they cover adjustable gastric banding, and what the requirements are. Take notes and have them snail mail you the copies of the requirements.

[budinindy 0]

Sarah,

I switched from M-Plan to Aetna back in Jan in order to qualify for bariatric surgery. With my plan...I had to either have a 6 month history of physician supervised diet and exercise in my medical records w/in the last 2 yrs...or I could participate in a 3 month pre-surgical regimen of physician suprvised diet, exercixe, dietician support, etc. I did the 3 months...collected medical records for the last 5 yrs...had three letters of recommentation (my PCP, my surgeon and the physician who oversaw my regimen). With all of that and 2 health issues (high BP and sleep apnea) I was approved in 8 business days after submission of my packet. It was a long process...a lot of hoops to jump through...but pretty painless in the end.

This is my experience w/Aetna...but what I understand....Aetna has different rules for different policies and riders. I met someone in my pre-op nutrition class that had Aetna and their policy did not cover bariatrics...so she switched to someone else.

Long story short...the advice already given is best...call the providers and see what each will cover based on the coverage your employer offers before making a choice. That is what I did...and fortunatelyt for me...my employer's policy w/Aetna covered bariatrics.

I hope this helps. Take care and good luck.

Bud