Aetna Confusion???

[acox1177 0]

I called Aetna today to ask them some questions about the surgery coverage and the lady said that my plan does not cover it. But in the same sentence she said that it still could. Has anyone had Aetna say their plan did not cover but ended up covering it?:thumbup::confused:

[ParrotheadCathy 0]

I would call back (chances are you won't get the same person twice) and ask your question again. ASK FOR DETAILS. Find out what their requirements are for approval .... Is there a minimum BMI? Must you have been at that BMI for a certain period of time? Documented weight loss attempts? (This could be as simple as your PCP having in your records that you were trying Weight Watchers or NutriSystem or Jenny Craig or whatever) What do they need to see to approve you. They will have specific requirements, and every policy is different.

If they say it isn't covered, ask if there is a written exclusion (somewhere in your policy it could say specifically that there is absolutely no coverage for weight loss surgery) because such a written exclusion cannot be appealed or gotten around. This is a hard one because nobody wants to hear this one. But your policy was decided upon by your employer, not the insurance company. Your employer decided what they are willing to pay for and if there is a written exclusion for WLS, then you are out of luck or self pay. I read a post where someone even called their state insurance commissioner on that and was told a written exclusion is Iron clad.