Question about Aetna

I live in California and just had RNY on 5-7-07. My very dear friend lives in Apopka, Florida. She has Aetna insurance. Does anyone know if Aetna covers the WLS in Florida? Any information you could provide would be wonderful. Thanks in advance for all of your help!! Sincerely, Heather

Hi Heather, I have Aetna and live in Florida. Many of their policies cover WLS provided the patient meets their criteria. Your friend should contact Aetna or her HR rep to see if her particular plan has coverage. If the employer did not purchase the WLS rider then there will be no coverage, even if your friend meets the requirements. I've included the link to Aetna's requirements provided she has the proper coverage: http://www.aetna.com/cpb/medical/data/100_199/0157.html Good luck. The insurance forum is really helpful if she runs into denials.

I forgot to add that if your friend lacks 6 months supervised weightloss Aetna will approve with 3 months current supervised weight loss as part of a pre-op diet. The specifics are spelled out in the link I pasted in my last post. Just thought I would mention it since this is different from most other insurances.

Hello I have Aetna POS Open acess I was denied two times & was approved after my external review. Took about 6 months from my 1st denial to get my surgery. But she really needs to call Aetna & find out if her specific plan covers it & get all her requirements from Aetna. Does she have a surgon yet?

I also have Aetna POS II through my hubby's employer which Wal-Mart and they totally have it excluded in their policy and won't pick up a rider.  Wal-Mart suggests that I save up 20,000.00 to have it done.  I was just wondering if yours employer had an exclusion or not or even if they picked up a rider?  I am thinking of appealing and if I am in the same situation as you and you eventually got approved after external review maybe I may have a little chance.  I doubt it but I won't give up!

I had Aetna at the time of my surgery. Feel free to check out my profile for any help it might give your friend.

Hi Heather, I had Aetna but had to file suit to get them to pay. Aetna does approve wls, but it depends on your friend's specific policy benefits. She can call me at 407-303-4574 (US Bariatric Orlando) and I'll be happy to verify her benefits. Take care, Kristen