Question:
What do I do now? exclusion

Well, I'm back again. I e-mailed Aetna and advised them of my situation, ie being morbidly obese and what problems I have that have come from that. Of course my plan has an exclusion policy. Basically my response was that my plan specifically excludes this type of procedure. Aetna says they do not standardly cover these services. They said the employer must purchase an option to allow the procedure to be covered on their emmployees, however my employer chose not to cover this type of procedure. Therefore AEtna cannot make an exception. So any idea what my next step is or should I just throw in the towel and try to lose weight on a diet program?    — Donna W. (posted on April 20, 2005)

April 20, 2005
Please read my profile and then contact me if you'd like to chat. My company also had an exclusion clause. (RNY LAP 12/17/04)
   — jenniferw

April 20, 2005
Hey Donna, What ever you do, DO NOT throw in the towel!! So this door seems to be closed; not all the way yet. Keep faith because even if this door is closed another one will be opened for you. Just don't give up! Good luck! Hugs, Debra H.
   — Debra H.

April 20, 2005
Hi You can go to your employer and ask them to make an exception in Your case, tell them if it takes you won't tell anyone who works with you that they did it for all they know you could have paid yourself maybe they would add that to your policy I have heard of employers doing that for there workes on a person to person case. Best Wishes
   — Shell G

April 21, 2005
I find that to be odd as Aetna authorized my VBG three weeks after my initial request. Granted that was 12/00. Look on Aetna's web site under their Clinical Policy Bulletins #0157 - I am going to try to send the link - good luck to you. This has been one of the greatest gifts God has given to me. http://www.aetna.com/cpb/data/CPBA0157.html Keep us posted. Kim
   — baloudoggy

April 23, 2005
Donna, Have you considered self-paying? My insurance coverage (both plans) had specific (air-tight) exclusions for WLS coverage, so I ended up self-paying and going to Spain and the wonderful Dr. Aniceto Baltasar for my surgery. I had an open BPD/DS on July 2, 2002 and have lost 210 lbs, a wheelchair, diabetes, congestive heart failure, hypertension, sleep apnea, GERD, stress incontinence - well, I was one sick puppy! I'm not anymore - plus, I have a fabulous quality of life with my surgery - and a wonderful friend in my surgeon! Consider checking out www.bodybybaltasar.com and www.drbaltasar.com, as well as www.duodenalswitch.com Let me know if I can answer any questions, okay? Blessings, dina
   — Dina McBride

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