Aetna policy bulletin

BillieC
on 5/24/07 10:09 am - Laurens, SC
I am pursuing WLS and have Aetna's PPO.  I read a post that had a link to one of Aetna's policy bulletins and I'm wondering if the same policy bulletins apply to all Aetna policies that cover WLS or if they have different ones for different policies.  Anybody know?
B Girl
on 5/24/07 11:17 pm

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.  

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