Aetna questions - newbie

jen0517 · 06-25-2008, 08:00 PM

Hi everyone,

I'm new to the forum and had some questions I'm hoping some of you might answer.

I have Aetna PPO. I've read the clinical bulletin regarding coverage of bariatric surgery. I understand that I need to have a BMI of >= 35 and either 6 months of a physician supervised weight loss program or 3 months of multidiscplinary team weight loss program.

Right now, my BMI is just over 35, but I have several co-morbid conditions (diabetes, sleep apnea, hypertension, high cholesterol). If I go on a weight loss program and my BMI drops below 35, will Aetna deny the procedure?

I'd appreciate any assistance. Thanks so much!

Jen

tashanicole1271 · 06-25-2008, 08:57 PM

Hi Jen,
I also have Aetna insurance, but mine is Open Access Aetna Select. My BMI had to be greater than or equal to 40.....I came in right at 40! Because of that, I wasn't required to have any co-morbid factors. I am about to start my third month of medically supervised weight loss. I am required to lose 10 pounds in this time span. In a nutshell, if your Aetna is like my Aetna, you should be ok beacuse of your co-morbid factors.

Tasha

ImGonnaLose · 06-25-2008, 09:33 PM

Just a tip - make sure your company does not have a WLS exclusion. I have Aetna, but my employer has an exclusion, so I had to self-pay.

-Marianne

purplecandle · 06-26-2008, 12:15 PM

if you get approved, make sure you have an extra 6000.00 to pay for the part they don't pay for.