Help ! I have Aetna PPO & they Excluded

jknsk2002 · November 7, 2007

Lap Band from me because my company has Small Business Insurance and it says that its not a covered benefit. How can I get by that ?? I feel I shouldn't be discriminated by that just because my employers are cheap and truley could opt for the large business insurance but I know them ( partially family) and they won't employ over the 50 people minimum to get that insurance just because of that am I am to suffer. I would have thought that PPO would be agreat insurance. But you can bet the boss gets everything of "hers" covered once it's denied and she's lucky she can manipulate the health plan to suit her needs and not the needs of the employees. WHAT can I do ? I am desperate ! Please help !

Susan :-(

marjon9 · November 7, 2007

Lap Band from me because my company has Small Business Insurance and it says that its not a covered benefit. How can I get by that ?? I feel I shouldn't be discriminated by that just because my employers are cheap and truley could opt for the large business insurance but I know them ( partially family) and they won't employ over the 50 people minimum to get that insurance just because of that am I am to suffer. I would have thought that PPO would be agreat insurance. But you can bet the boss gets everything of "hers" covered once it's denied and she's lucky she can manipulate the health plan to suit her needs and not the needs of the employees. WHAT can I do ? I am desperate ! Please help !
Susan :-(

Susan, when it comes to insurance exclusions sometimes there is just nothing you can do. I would get some advice on how best to present your case and then appeal the decision to the insurance company if there is any gray area. But there may not be.

Many other people have been in this position, and many of them eventually come to the point where they figure out a way to self pay. My doctor (link is in my signature) was only $9950. Some of the Mexican doctors are even less, around $8500, and many people here have used these doctors with great success.

The truth is, even if you pay for it yourself, you will still very likely come out ahead when you consider the lower medical bills in the future for obesity related health problems, lower food cost, and overall better quality of life.

I wish I could tell you that there is a sure way around the insurance exclusion. But sometimes there just isn't.