Aetna PPO help!!

[redlilie 0]

Hi, I am attending a lapband seminar this monday. I have been looking over so many threads to find answers and have read so much info that has helped. I have Aetna PPO and I have looked in the benefit book and this is what it states:

Medical Exclusions:

Charges for surgical weight reduction

procedures (such as stapling the stomach) and all related charges, unless a physician certifies that the condition is potentially life threatening and and all other courses of treatment were unsuccessful.

I really just want to know as much info as possible. I have read some threads about having 5 year medical history about weight. Has anybody gotten approved that didnt have that. I only went 1 time in 2003, 2005 to the emergency room due to acid reflux being so bad and then 2008.

Thanks for any help!

[Jodi73 11]

Look on Aetna.com at the Clinical Policy Bulletins. That will give you details about their policy. Some companies DO exclude weight loss surgery, so check that with your workplace HR office. I cant quite tell, but it sounds like your policy will cover as long as a doc deems it necessary. But, you cant really tell since it does mention the "death" part. Yikes, thats sounds bad! Talk to your PCP, check out the website, and by all means pursue this if you really want to! Aetna is really good to approve, so keep your head up! Good luck! Jodi

[pixieinyourpocket 0]

I also have Aenta PPO, several people that I know that have gotten the band that had the same insurance has said, "you'll get it." It has only been a week and nothing yet in the mail, phone call, or site check.

[WASaBubbleButt 41]

I also have Aenta PPO, several people that I know that have gotten the band that had the same insurance has said, "you'll get it." It has only been a week and nothing yet in the mail, phone call, or site check.

Aetna does cover WLS but not if it is specifically excluded. It is an additional premium and not part of major medical. So if someone has WLS benefits under Aetna, it would be covered if they meet the requirements. If someone's else's Aetna policy specifically excludes it, it will not be covered.

IOW, not all Aetna policies cover the same things.

Hi, I am attending a lapband seminar this monday. I have been looking over so many threads to find answers and have read so much info that has helped. I have Aetna PPO and I have looked in the benefit book and this is what it states:

Medical Exclusions:

Charges for surgical weight reduction

procedures (such as stapling the stomach) and all related charges, unless a physician certifies that the condition is potentially life threatening and and all other courses of treatment were unsuccessful.

I really just want to know as much info as possible. I have read some threads about having 5 year medical history about weight. Has anybody gotten approved that didnt have that. I only went 1 time in 2003, 2005 to the emergency room due to acid reflux being so bad and then 2008.

Thanks for any help!

Sadly, if it is excluded - it is excluded.

If it is covered here are the requirements:

Aetna Insurance - WLS Benefits - Vertical Sleeve Gastrectomy Surgery (VSG) Forum

[Beachburd 0]

I have Aetna PPO as well. I called them prior to my first seminar to ask if they covered weight loss surgery and was told that it was a covered expense.

I proceeded with their requirments which included a 2 year weight history which basically was just a documented weight from my primary physcian 2 years in a row-simple.

I completed my 3 month requirments and was approved in the same week and have a surgery date of Sept 1, 4 months from my seminar date:)

I hope this helps!

Good Luck as you move forward!

Kim

[SpiritDriven71 1]

The company I worked for had BCBS. I was covered, I had my Surgery 03/17/09.The company was bought out this month. The new Co.has Aetna POS II. They do not cover any Bariatric services . I just got off the phone with the Aetna Rep.

It really depends on what your Company purchased in terms of Health Coverage. Call Aetna, your HR dept. and Docs office to find out.

[oc_caligirl 0]

The insurance verifiers usually help you. This happened to me too. I have BCBS and the handbook says it does not cover and I called them and they told me the same thing. I went on the 1800Getslim website for free insurance verification and they told me my insurance covers everything. ??? I don't know how that happened.