Question:
MY employer has health insurance through Aetna, which policy should I
pick out..which one will pay the quickest without much hassle. I live in Texas! — [Anonymous] (posted on June 4, 2001)
June 4, 2001
Consider yourself lucky that your employer offers Aetna! I hear that they
are one of the best in approvals! That being said, I have an HMO plan. I
paid $15 for my initial consultation with the surgeon and not a dime in the
hospital. I was approved in less than 24 hours. I know that a lot of
people are turned off by HMOs but I lucked out. My mother had to go in the
hospital for a heart catherization under the PPO plan, and had to pay about
$900. Boy, was I happy with my HMO. And I had a top notch doctor.
— Jeannet
June 4, 2001
You need to know the policy the employer has first. Just because they have
Aetna dsn't mean contractually they have approval for WLS surgery. There
are many Aetna policies that have WLS exclusions. Mine was one of them
until a strike contract radified the contract and now my husbands policy
offers WLS as of 1/1/01. When Aetna pays most policies cover the RNY but
not necessarily the BPD/DS and others. So, contact the human resources
person or Benefits Coordinator and find out exactly what is covered under
this policy before you make a choice. Could be a big difference. Best
wishes
— Linda M.
June 4, 2001
I also have Aetna US Healthcare HMO. I was approved in 4 weeks. They also
paid 100%. I live in TX.
— jmasks
June 5, 2001
AETNA IS THE BEST. I WAS APPROVED IN TWO HOURS. AETNA HMO IN OHIO WAS THE
INSURER. GOOD LUCK.
— MICHAEL Z.
June 5, 2001
I have Aetna US Healthcare, they approved me in 2 hours over the
phone....If you go into there web-site, and search Morbid Obesity, It will
come up, that they cover the surgery.
Good Luck
— Marie B.
June 5, 2001
I just switched to aetna hmo myself. your employer may have a clause that
excluses WLS surgery. they do that to save money. The best way to fond out
is to ask your human resources department for the "group number"
that your job is identified by with aetna. My job acted like they didn't
know it, so i got resourcesful. I asked a friend who had aetna what her
group # was. I assured her that i wanted to check on the coverage they
offered, but did not tell her specifically what i was looking for. Then, I
called aetna at 1-800-323-9930 and told them it was open enrollemnt at my
job and that their web site and my employer did not provide me with enough
info. I specifically told them that i wanted to find out what exclusions
were in our contract. They searched and then i got more specific and asked
was there a clause or exception against "surgical treatment of
obesity" they told me no. I am really paranoid so i called back 4 more
times throughout the day and spoke to a new person and asked all over
again, just to be sure. Also, this is the page from aetna's web site that
shows how they handle approval for surgery. As long as there are no
exceptions in your contract they will follow this:
www.aetnaushc.com/cpb/data/CPBA0157.html All policys under Aetna follow
this regardless of whether they are HMO, PPP or QPOS. The only reason to
not pick the HMO is if you have a doctor you plan to go to that is not a
netwrok provider. If you have a few docs that you are thinking about, use
Aetnas web site again and go to "choose a provider", put in your
location and try different surgeons names. If they don't come up, they are
out of network and an HMO may be a poor choice. I found that all but one of
the doctors I was considering was in network, so I picked the HMO. Good
luck!
— Courtney W.
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