Well my surgery is off for now.

08-04-2005, 06:05 AM

I went to the seminar last night and got really excited until they told me that Aetna will not cover my surgery. What sucks is I changed my insurance a year ago. My company offers another insurance that will cover it. But I am unable to change my insurance until next july. So I guess it is a waiting game now. By the way I have Aetna EPO OPEN ACCESS.

HotLikeHer · 08-04-2005, 06:48 AM

Just check with your insurance company yourself though too,

I have BCBS, and BCBS of FL stopped covering it, but I have BCBS _Empire and it is covered... Dont get discouraged, check things out......

08-04-2005, 08:22 AM

I am trying to change my insurance... Our insurance year only started in July. So I have my fingers crossed, they will let me change to BC/BS. I have been told by the doctors office they have no problem getting approval from that insurance.

keri · 08-04-2005, 09:07 AM

Did you apeall to Aetna? I have Aetna and they out right declined it- but with the help of the surgery center and my primary care physican- we appealled with letters and a few months later they reversed theri original decision.

I know all groups are different- but it's worth a try.

Best of luck to you.

Mystyblu · 08-04-2005, 08:07 PM

Billy,

I have Aetna EPO also and when I called and talked to them the representative told me they do cover WLS and directed me there information site. They cover both forms, RNY and the band. My doctor’s office specializes with several insurance companies and Aetna is one of them. They just told me that Aetna is kind of strict about the paperwork. That’s why I have to complete the 6 months of doctor supervises weight loss program to complete my documentation. After that I should be good to go.

Give Aetna a call and see what they say. Maybe you have a doctor’s office in your area that has already dealt with Aetna and knows how to work the documentation.

Good luck

_____

Not banded yet. 5 months and counting.

**Alexandra** · 08-05-2005, 08:58 AM

I had the same situation, Billy, and was prepared to wait 10 months to change insurance carriers at my firm's open enrollment. I used the time to get all the medical testing done (which Aetna did pay for, since it wasn't necessarily surgery related) and then submitted a request for precert just for the heck of it. I was immediately denied, so I appealed. Then again. And then I took it to third-party review and WON!! My surgery was way earlier than it would have been if I had just waited to change carriers.

None of this cost anything but time, and I was absolutely thrilled to beat Aetna. Why not use the months in the interim to try?

MaryE · 08-23-2005, 08:18 PM

I also have Aetna. I live in NY. I will not take no for an answer. I was told by my surgeons office that Aetna will never approve the Lap Band. It is covered by Aetna. If your BMI is over 40 you will have no problem. If it is between 35-40 It gets a little trickier. You need to have comorbidities.
If you can afford it (some visits are not covered by aetna) such as the Psych exam and the visit to the dietition aetna will cover all the other tests. Just speak to your primary physician and put causes such as shortness of breaty for the pulmonary dr and the cardiologist. I wont give up I am going through the tests. You can also appeal. Move ahead if this is your last option for a new life as it is mine.