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I am trying to work through the Aetna system and so far, have been met with a lot of frustration. I was told to check on my approval by my bariatric provider. So, I called Aetna and was told that my policy did not cover bariatric surgery. HOWEVER, I know several people who have my exact same policy in my company who have had the surgery. No, they did not self-pay or go to Mexico. There has to be something that I am not doing correctly. I am appealing to you--what do I need to do? How do you get approved? Aetna is sort of vague on their website. On one hand, they say that tell you the exact steps that you need to take in order to do the surgery. I'm on board with that. Trying to get all of my stuff together. NO PROBLEM. My bariatric provider (on my first visit) went on and on about what I need to do (mirrored exactly what Aetna said on their website). BUT... also on their website it says that they don't cover bariatric surgery. Am I using the wrong words? I told the Aetna rep, when I called, do you cover bariatric surgery? She said, "No, we don't." I asked about riders or buying coverage.
How did you navigate the Aetna maze? What do I have to do to get covered? I have an appointment in 3 weeks with my surgeon. Do I let the provider submit it and then be rejected? What are the steps that I need to take. And, no I can't discuss the surgery with those that had it. They are in another state and I would not feel comfortable in broaching that subject.
THANK YOU!
Aetna covers WLS,IF,your employer bought the coverage for their employees. Maybe your co workers bought a different,more expensive plan that includes it? Or maybe they had secondary policies from their spouses? How do you KNOW they have the exact same policy that you have if you are not comfortable talking about it with. Them?
aetna will tell the ppl whose policy does include the coverage what to do. They won't discuss. It with ppl whose policy excludes it.
Youneed to request a a copy of YOUR plan from them as that will tell you if it does or does not cover.
The plan information on line is pretty generic. It intended for general information then you have to look at your particular policy to see if it. I included or excluded.
I have bcnm retired, moved to Florida to care for parents, have been going to my Nutrition classes.
now I find out they want me to go back to Michigan to have it.
any chance of an Appeal?
Kermit
Does anyone have an appeal letter for a panniculectomy/ abdominoplasty that they would like to share?
on 4/3/16 2:45 pm
Yes on my end in pa nothing too ... Awful
on 4/3/16 2:44 pm
Check your state I live in Pennsylvania Blue Cross Blue Shield independent and they do nothing if you have an independent program as in not with a group there will be no coverage in pa have tried multiple
on 4/3/16 2:42 pm
Yes independently Pennsylvania nothing but rejection multiple times not even for removal of a lap band
Hi Nan2008,
I know you posted this response 5 years ago. But, I was hoping that maybe you can help me with my appeal letter too. I was denied surgery by Aetna because they said that I gained weight during my supervised nutrition program. I'm desperate to get this surgery. Hoping you're still on this forum.
-Khoney3
Tricare did not pay for my lapband surgery in 2006. I had private insurance at the time that covered the surgery. I married my husband in 2010. I had my lapand removed during my hysterectomy.I carry my private insurance as a primary insurance and Tricare Prime as secondary. Since my primary insurance approved my hysterectomy Tricare picked up the "remaining" cost that included my lapband being removed. We had to make sure my GYN surgeon opened me and closed me, the lapband surgeon came in to remove adhesion's so the GYN surgeon could perform my hysterectomy easier. The lapband surgeon removed my band while he was in there. My primary denied the lapband surgeon fee but Tricare covered it as the secondary insurace along with the other fees from the hyst. Kind of a special situation but both surgeons want my band out and for me to have RNY so they worked together to help get it done. My band was ineffective I lost 100 in the beginning but after that it was a struggle with getting the right fill and I just got so frustrated with it. I ended up with GERD and tons of adhesions.
jacqie
My primary insurance is Self Pay through my husband's employer and they have a specific exclusion for weightloss surgery. Medicare is my secondary and I know that it will cover a D/S.
I am trying to figure out a way to get my surgery paid for and if Medicare will pay if the "Medical Necessity" for my surgery to my primary insurance fails to provide a one off approval.
Presently I have a 56.5 BMI and a bunch of comorbidities, along with already having needed two spinal surgeries, one, most assuredly is due to my weight.
Has anyone had any luck with this?
Cheers,
RhainyC
if there is an exclusion on your primary policy, even "medical necessity" won't make them cover it. Your best bet is to go right on to your secondary.
Hockeymom87 · 0 replies · 674 views
