OK, so I looked in my Aetna insurance book

and under " General Exclusions " it says : Weight control services including surgical procedures, medical treatments, weight loss programs, dietery regimins and other services primarily to control weight....... Does that mean I have NO chance of them ever helping me out with this cost ?? Or Should I even bother ?? It is Aetna PPO.. Is there any other way around this ?

It does not look good. What you need to do is call your rep with Aetna and clarify it with them as to YOUR particular policy. Sometimes those are general publications that are issued. Sometimes individual policy holders have additional riders. As far as any other way around it - if it is an exclusion, no even if it is medically necessary for you to have surgery they will not budge. Chris

The SPD for my insurance says the same thing, but I was approved. The rep stated my company either had a general SPD or it hadn't been updated. Nothing beats a failure, but a try. The worst you could hear is no twice! Remember there's always the appeals process. Good luck to you.

It does sound that that's an exclusion for WLS, so your insurance plan does not cover it. There is no way around it unless you have the option to change to a different plan that doesn't have that exclusion. You may want to check with a rep from your companies HR department. It's the company, not the insurance company that sets the exclusion. If you can convince them that they will be saving money on medical bills but allowing this surgery for you you may have a shot. But it's slim at best.

I had nearly the same wording in my book, my out was the diagnosis of "exogenous morbid obesity" apparently they excluded treatment for obesity but not the other. Weird or what? I'm happily on the losing side and would lay down tomorrow as a cash pay patient to do it again if I had to.

My insurance policy said the same thing. If the surgery is for weight loss only, they would not have paid it, but because of the co morbidities (in my case diabetes and gerd) they did pay for mine for treatment of diabetes. YOu should definately give it a try, especially if you have any co morbids. I was approved in only 6 days. Good Luck. Sandy

Susan, I used to work for an insurance company, they usually put that in their exclusion section because they do not want people getting wls who just want it for cosmetic reasons. They are not talking about excluding the surgery for those who need it due to medical necessity. If you have a legitimate medical reason for having the surgery then they will take all the info provided to them by the doctor's office and send it to the medical review board for consideration. Do not take this as a no. Yvonne