What the...?! Did AETNA just lie to me?

[Guest BikiniBeachy]

Do they think we are all stupid and haven't researched this before we contact them? I e-mailed Aetna last night asking which plans do not exclude bariatric surgery and this the EXACT e-mail I just received;

Thank you for your interest in the Aetna Individual plans. Unfortunately

Aetna does not cover Bariatric Surgery and depending on the

circumstances surrounding the medical necessity for the surgery you

could be declined for coverage under our individual plans. At this time

you can contact the guaranteed issue plans in your state at

1-877-461-3811.

Sincerely,

Aetna Individual Advantage Plans

Direct Sales Team

OK...So how are some people on here getting this if my doctor and you guys say Aenta DOES cover it? I'm really fuming....:thumbup:

[kellygirl0520 0]

Do they think we are all stupid and haven't researched this before we contact them? I e-mailed Aetna last night asking which plans do not exclude bariatric surgery and this the EXACT e-mail I just received;

Thank you for your interest in the Aetna Individual plans. Unfortunately

Aetna does not cover Bariatric Surgery and depending on the

circumstances surrounding the medical necessity for the surgery you

could be declined for coverage under our individual plans. At this time

you can contact the guaranteed issue plans in your state at

1-877-461-3811.

Sincerely,

Aetna Individual Advantage Plans

Direct Sales Team

OK...So how are some people on here getting this if my doctor and you guys say Aenta DOES cover it? I'm really fuming....:thumbup:

Do you have insurance coverage through your employer or are you looking at purchasing a policy through AETNA. If you have coverage through your employer, call the benefits coordinator in your HR department to see if your policy has a direct exclusion for the treatment of obesity. You can also usually find this information in your benefits policy if you have a copy of that. Good luck.

[Nursienicole 0]

Kellygirl is right. If the insurance is through your employer they may have what is called an ASO (or Administrative Services Only) plan through Aetna. If this is the case then it is your company that actually pays the medical bills, they just use Aetna to do the administration (ie. processing claims, utilization management, etc). If that is the case then your company would have a specific contract with Aetna indicating what is and isn't covered and that could very well include Bariatric surgery even if Aetna does not provide this to its fully insured members (meaning Aetna pays the bills). I work in insurance and my company does not cover IVF however we have contracts that are ASO contracts that do, so if a person checked with the company we would say we don't cover it because we dont, but if they had that particular ASO contract it may be covered. Does that make sence?