Question:
Does anyone know about Aetna's coverage in OR?

I have not received my summary of benefits and I'm going crazy trying to find out if my new (july 1) insurance company will cover the surgery. I have researched the Aetna website and found no exclusions to obesity treatment but that just seems too easy to be true! I am paranoid that if I mention surgery to my pcp (who will remain my pcp with new ins)Aetna will say 'pre-existing'--this IS true in that I have been severely overweight all my 30 years and diets, exercise, Xenical and Omnitrition have not worked! Anyway, does anyone have any information that might be useful? I don't know if I could handle the appeal process.    — jenn2002 (posted on June 12, 2001)

June 13, 2001
Gosh, do I know how you feel! I was terrified I would say the wrong thing to Aetna. But, after several weeks with no info, I decided to get brave. I just asked if Gastric Bypass surgery was excluded. I was told it was covered if medically necessary. I then asked what they would need from me. The person I spoke with wasn't really supportive, but he did give me the info I needed to gather. Your doctor's office will do the rest. Good luck. Debbie
   — deb_wls2001

June 13, 2001
I am in a similiar situation as you. I am keeping my same PCP. That helps. My aetna starts july 2. i told him what i wanted a few weeks ago. He said he'd do the referral when aetna starts on the 2nd, because he'd just have to do it one time. Remember that your physician does not have anything to do with the whole preexisting thing. tell him you want a referral for the week that aetna starts. You know whether he is supportive or not. Also, the prior condidtion thing does not apply with aetna if you have been continously insured, i checked! I have researched and aetna does not have an exclusion against wls. Your employer, however, may have one. What i did was call with the group # and asked aetna directly if their was an exclusion in my contract (put in by my employer) they were so so so nice. They read all the exclusions to me and none were related to wls. I am super paraniod-so i called again like six times and spoke to new people and asked about it agian-then last week i did it again. Aetna's # is 1-800-323-9930 and 1-800-443-6917. One is just for georgia and one is nationwide, so try them both. Good luck!
   — Courtney W.