Aetna

CindyCam · 03-26-2006, 06:08 PM

:help:ANYONE OUT THERE HAS AETNA MANAGED CHOICE....I HAVE NOT YET APPLIED. JUST WANTED TO KNOW IF ANYONE ELSE HAD TO DEAL WITH AETNA AND IF THEY GAVE PROBLEMS.

**Alexandra** · 03-26-2006, 06:45 PM

Cindy, you will not be happy to hear that Aetna is possibly the least band-friendly insurer out there, outside of plans with full exclusions for bariatric surgery. Do you know if your plan has such an exclusion? That's the first question to ask.

If it doesn't and you have one of Aetna's standard plans, you may still have a fight ahead of you. Here are the first questions you have to answer:

1. Are you medically qualified for bariatric surgery? (That is, is your BMI over 40? Or is it over 35 and you have medical conditions caused by your weight?)

2. Do you have medical conditions that would make RNY surgery unadvisable? RNY gastric bypass is still Aetna's preferred treatment, but they will allow banding under certain circumstances if you have contraindications for bypass.

3. Have you been trying to lose weight under a doctor's supervision for at least six months? If you haven't the first thing you MUST do tomorrow is make an appointment with your primary care doctor to talk about your weight. Get medical and exercise advice (no doubt they'll have it all printed up to hand you) and make a plan to visit at least twice a month for the next six months to check in and get weighed. This is REQUIRED by Aetna and you can't move forward if you're not under a PCP's care for this already.

4. What state are you in? Some states have better than protections that others when it comes to medical decisions being made by insurance carriers. It's not true for every state, but if you are in NY, NJ, CT or CA I know Aetna has been forced to pay on third-party review. I'm sure there are other states with such protections; call your state department of health to find out if you do.

Good luck!!