Question:
Does anyone know if HMO's pay for WLS, I see alot of PPO's that do but not HMO's HELP

   — Kim L. (posted on March 5, 2003)

March 5, 2003
I have Aetna HMO and they approved me last year for the surgery (I had mine in July) and they recently approved my wife for her upcoming lap RNY in May. Aetna has recently revised their criteria though. The coverage policy bulletin is at http://www.aetna.com/cpb/data/CPBA0157.html JR
   — John Rushton

March 5, 2003
I had Cigna HMO and they approved me last year.
   — Beffy W.

March 5, 2003
I have Humana HMO and had surgery last July. We have just started the process for my hubby. I've heard a rumor that Humana may be changing their policy this summer.
   — Sunny S.

March 5, 2003
I have Humana/ChoiceCare HMO...I'm approved for surgery on March 31st.
   — Renee B.

March 5, 2003
There is no pat answers. It's how the policy is written and whether the employer has asked for any additons or deletions. There certainly are a lot fewer HMO's out there that cover it but there are some, so just do your homework very thorough. Not all PPO's or Fee-for-Service contracts will cover it either, so there is no sure thing but to look at the policy you have or are changing to very carefully.
   — zoedogcbr

March 5, 2003
Approved with Cigna HMO. (Never even saw a bill!)
   — jen41766

March 5, 2003
I have Pacificare HMO that paid for my surgery(and I never saw a bill either. Good Luck!
   — toni D.

March 5, 2003
hi there :) at the time of my open rny i had bcbs of il, they aproved and paid 100 percent, no problems no stalling etc. got aproved in 1 week! :)
   — carrie M.

March 6, 2003
Great Thanks everyone...that all makes me feel better...I will have BC/BS Carefirst(Blue Choice) from a company in Maryland when my husbands insurance comes into effect June 1st. Seems like forever...I CAN'T WAIT! Have a BLESSED Day!
   — Kim L.

March 6, 2003
I had an HMO and it paid 100%, and my surgery and hospital stay was right at the $40,000 mark.
   — Lynda T.

March 6, 2003
I have Kaiser HMO (Southern California) and they are paying for it 100%. My surgery will be done at UCLA (Kaiser So.CA contracts out to UCLA & PBC). Best wishes to you..aims
   — chickiewickie

March 6, 2003
Kaiser paid for me 100% $30,000
   — ~~Stacie~~

March 9, 2003
I had an HMO when mine was done and they paid 100% of the surgery cost. It aws about 45,000 because I had some problems in the hospital.
   — smedley200

March 10, 2003
I have M-Care HMO, this January they pay for WLS 100% with a $1,000 co-pay.
   — real S.

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