I have Aetna PPO, what do u think the

chances of me getting covered for this surgery are ? I have a body mass index of 41... I dn't have my consult until the 25th ...... Does any one have any experience with Aetna ??

What does your policy say about bariatric surgery? That's the place to start.

You meet the criteria with the BMI but you need to go with what your particular insurance policy says. Did you check with them to see if it is a covered benefit or if they have an exclusion? Chris

I had Aetna PPO almost 4 yrs ago and they denied me twice, my IBM was like 41 or 42, well they said I had to have a 5 yr supervised diet by a Dr ect.. they kept giving me the run around, denied me twice, Finally I hired Walter Lindstrom the obesity lawyer from California, I hired him in Nov and by Feb it had been over turned and I was approved. I think I paid him $1200. but It was worth the moeny! I would have had to self pay if I had not hired him! He does have like a $800 plan but then he doesn't work on it as fast or do as much for you as the $1200.00 plan. Good luck! Hoefully they wil approve you! If they don't then just look up Walter Lindstroms info in the obesity help library! I dont know his number ect.. any more! Good Luck! See ya lighter! Cyndi PS WLS was the best thing I ever done! I am now a size 10 and had my full tummy tuck 18 mths after wls! I love me body now!

Thanks for the information on the lawyer, but what do they do that gets you approved ?? I mean, I can prove that I have been this weight ( or around there for more than 20 years) what more proof do they want ?? If that doesnt say I can't do it with a diet program ( 5 years or 2 months, lol) then I don't know what does ?? I have looked online at my medical program and I am not able to find anything on Bariatric surgery ?? My mom owns the business and I was wondering does she have "ANY " pull on whether or not the insurance approves this surgery ?? Since she "did" approve this health plan ?? Can she pay more in a premium, and would that help...?

Actually, your mom should contact her insurance broker to see if it is feasible to take out an extra rider for the surgery. That would be a possible "pull". Basically, I think they will say that she signed a contract for ins X (fill in the blank with or without bariatric coverage) and usually you have a contract year from January to January. She may be able to add the rider come next January. Many insurance companies will want the BMI to be over a certain number for a minimum of 5 years. That means that you CANNOT go below that during that time. Most will deny on that. United Health care did for my sister. She only had 2 years of being morbidly obese and 3 years of being obese. As far as an attorney helping you that is an idea to consider but I think that you need to have an actual written denial(s) in your hands for that. Good luck and keep us posted. Chris