Aetna policy bulletin
Hi Billie! It depends on your particular policy. Self-funded plans (meaning your employer is actually paying the claims) can set their own rules/guidelines for WLS. Some self-funded plans specifically exclude it under any and all cir****tances. If that's the case for you, only your HR department can approve you. I've heard that overturning employer exclusions is the hardest. I personally have a self-funded group plan that covers WLS provided I meet Aetna's medical necessity. Basically, they approve it based on Aetna's guidelines that you found online. If there is coverage for WLS then there is a good chance that you'll be subject to the guidelines posted on Aetna's website. If your policy is not self-funded (meaning your policy is a true Aetna product) you should be subject to the guidelines online.