Question:
HELP~Aetna choice pos2 or BC/BS National {empire} I have to choose by friday!
My husbands company just sold out to L3 communications and they are swithching insurance which is kinda good because I wasnt getting anywhere with the old one..Anyway They dont let you look at the full policy's so I don't know what to do! If you have either of these specific plans please give me some feedback I am sick of this 6yr battle with insurance maybe this is my break! Thanks you guys! — witchywoman (posted on July 11, 2006)
July 11, 2006
Since each employers insurance contracts can be drastically different as
far as what is allowed and what isn't, I would call each one individually
and ask them for their requirements/restrictions etc. From what I have
heard it is up tothe employer whether they want to pay for this option for
their members.
Good Luck, 6 years is a long time to wait!!
— kimmy
July 11, 2006
I would also call and find out if the surgery is specifically excluded by
the company. I had Aetna POS through my ex and that is how my surgery was
paid.
— *Malena* M.
July 11, 2006
I have Aetna Open Access. It's been great. But every plan is different.
And every employer is different. It's ridiculous they won't let you look
at the plans before you decide! It may take some research but I agree with
the others, call both companies. A side note - get anything you can in
writing and get the names of the people you talk to. Good luck! You
deserve all the best!
— platypus
July 11, 2006
Since you didn't say what state you're in here is a link that provides all
the companies for BC/BS.
http://www.bluecross.com/listing/index.html
Access the website of Aetna as well and there should also be a phone number
on the documentation you are completing for insurance. If there is a PPO
choice, I suggest going with that because with some insurance companies you
don't need a referral to have the surgery. The only thing you will need
from a PCP is documentation of 6 month weight loss program. Sounds like
you've been dealing with doctors that don't know how to write you the
paperwork so that you will be approved.
Carefully read whatever paper the company has provided to your husband.
Also check your states insurance codes to see if they have laid out any
specifics that companies must allow the surgery --they did here in
Maryland. If a company in Maryland employs more than 50 people, the
employee can't be turned down for the surgery. If you want some help in
researching the issue, let me know what state you are in and I'll look up
the codes to see what the states insurance commission says on the subject.
Just email me directly at [email protected]
— the7thdean
July 11, 2006
Thank you all so much for your replies, I am in florida and have battled
with several different ins companies and doctors over this in the past 6
yrs then one of my pcp's died and i have no idea where my medical records
are then company was self insured and refused to pay, I have a referral
waiting with a med ness now just trying to find out which one of these
companies has the least hoops and proper wording in the exclusion because I
know my luck there is gonna be an exclusion!!
— witchywoman
July 11, 2006
I have aetna and have been approved on the first try.They have been really
great so far.
— renee44127
July 11, 2006
I have AETNA Choice POS2 and they have been really great so far!! I have
just had my psychological evaluation and can't wait for my next step! Good
Luck!
— Jodie B.
July 12, 2006
I have Eatna POS II and they paid for my gastric bypass. i know they were
going to change their policy, but you should be able to check it out at
their website. Look for the clinical guidelines for gastric bypass. I had
to have a doctor-supervised diet (although I already had) for six months,
plus an exercise physiologist-documented exercise program. they also
required endoscopy, colonoscopy, cardiac evaluation, sleep apnea
evalutaion, and psychiatric evaluation.
I advise you to go and look up thier exact requirements, then begin them.
At the same time, schedule your surgery for about a month after cyou will
complete your requirements, so you can have the surgery ASAP!
— Novashannon
July 17, 2006
If you haven't already chosen, call their HR department and ask for
specifics on the policies.
— gkeith1971
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