Insurance covers Gastric Bypass and no Banding !!

[Jmone 0]

I am so upset , not to mention hurt . I did my 3 month diet plan with Aetna Pos II( I also have Aetna HMO as my secondary), and my surgeon scheduled me for 3/30/09.. I do have sleep Apnea and BMI is 39.9. With Aetna POS II you need to have a BMI of 40 or more for two years or 35-39 for two years with a co-morbidity. I was perfect . I was originally at a BMI of 42.4 with efforts I was able to drop some punds and have been at my current weight for months . I also have PCOS so it is just that much harder for me to lose. I requested a copy of what my employer covers and it states that they only cover gastric that banding is not covered at all. I am so upset and hurt . My only hope is through my secondary but that is much harder for me as they require severe sleep apnea and 40 plus BMI . I feel like my dreams were shot down right before my eyes ... Has anyone else experienced this . If so ...Please help me get through this .

[adagray 1]

This doesn't sound right to me that one would be covered and not the other. Did you get this documentation from your employer or the insurance company? I'm just thinking that maybe if you got it from your employer's HR dept, then maybe someone messed up and gave you outdated info (since banding used to be considered 'experimental').

[karen_karen 0]

sadly some insurance companies dont what to handle the post treatment since it can get pretty costly..

[ait 0]

Are you sure you read correctly? I also have Aetna and they definitely cover the band, just the way it's worded may be confusing. Why don't you call an Aetna rep and make sure that it's not covered. It would be wierd if your employer chose to just cover gastric bypass and not gastric banding...

these are what aetna covers - i bolded the band

open or laparoscopic Roux-en-Y gastric bypass (RYGB), open or laparoscopic biliopancreatic diversion (BPD) with or without duodenal switch (DS), or laparoscopic adjustable silicone gastric banding (LASGB)

good luck!

[MacMadame 81]

I have Aetna too and they cover band, bypass and DS.

[Jmone 0]

Exact wording word for word is :

Obesity Surgery limited to gastric bypass as long as the following conditions are met

and it goes on to say the conditions then it says :

" Gastric banding/ Lap band surgery is not covered"

My secondary AETNA does cover banding , it is just harder to get coverage from HMO than POS II... I am hoping to get approved soon by either

[ait 0]

So wierd! Hope you are able to get approved through the secondary insurance.