Question:
Is Aetna HMO or PPO better for approval of surgery?

My company is changing insurances and I have to choose coverage. With surgery this summer, I'm wondering which will guarantee me the best chance at a quick approval: Aetna HMO, PPO or something else?    — duane B. (posted on May 10, 2003)

May 10, 2003
I currently have Aetna PPO and I am in the process of getting my 6 month physician supervised diet. I would suggest the PPO because you have the freedom to choose what Physicians, Specialists, Hospitals, Surgerons, etc that you want, although I would advise you to stay IN NETWORK (with a contracted healthcare professional so your out-of-pocket is not too high) that way, you will not have to deal with referrals or feel restricted. I will email you the requirements placed on WLS by Aetna as of Jan. '03.
   — Shayla527

May 10, 2003
I just checked the Aetna website and this is what is states under different Plan types, ie HMO,PPO, POS, QPOS, etc...Policy Note: Most Aetna HMO and QPOS plans exclude coverage of surgical operations, procedures or treatment of obesity unless approved by Aetna. Please check benefit plan descriptions for details.
   — Shayla527

May 10, 2003
I had HMO Open Access (Aetna) and no problem gaining approval... I did have to go to St. Louis from Kansas City area for a network Dr. but that wasn't a problem for me...
   — MF

May 10, 2003
It's hard to say b/c even if we all have AETNA PPO, there are so many different plans based on different companies, etc. But I had AETNA PPO and was approved for surgery last year within a few weeks. I heard the policy changed a little bit since. I really don't know much about their HMO plans, so I cannot compare. But I can say that like the previous poster said, you have so much more freedom. And with no referrals needed, you can get things done alot quicker. Goodluck to you!
   — Lezlie Y.

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