anyone have aetna?
Yeah....what Angie said 
99.9% of ALL insurance companies cover WLS....they just have a million different plans for the employers and the employers try to get the best plan for their employees they can for the money they can afford. Insurance is a HUGE cost for employers and it's hard to get plans for their employees that cover everything. I work for Uncle Sam....and we have a great policy...but having a large employer like that...they can afford it. I pay $200/month for my insurance...the government pays $700/mo for my policy....that's $900/month just for health insurance....that's big bucks for a small business. I know everyone complains about the insurance companies and how tight they are...but they are a business and they are entitled to make a profit...just like we are entitled to get paid when we work. But did you know that the surgeons get $6-8,000 for their 1-2 hour surgery? And the hospitals get $200-500 a day for that bed you sleep in? And the nurses make $30-90 an hour. Then ya have the drugs used and the anethesist and the janitors and the insurances the medical professionals pay (up to $80K a year in liabilty insurance for a surgeon)...the list is endless. And none of this is going to be free to anyone...someone, somewhere is paying for it. So while I hate the fact that there are policies out there that don't cover WLS....I do understand why. It is all a matter of how much the employer can afford for the best policy they can get. It's like cars...some people drive economy cars and some people drive big expensive luxury cars...the more ya pay...the better the car and options. But both cars do the basics...they get ya from point A to point B....like insurance...they all cover the basics...but some have some added benefits based on the money spent.
But my heart goes out to anyone who is not able to have WLS due to insurance companies. Maybe some of those surgeons out there making $600K plus a year would consider doing some pro bono work eh? Maybe those hospitals could cut a break here and there instead of building new hospitals that look like Hiltons?
Good luck with your journey....I hope you find out that your policy covers WLS 
99.9% of ALL insurance companies cover WLS....they just have a million different plans for the employers and the employers try to get the best plan for their employees they can for the money they can afford. Insurance is a HUGE cost for employers and it's hard to get plans for their employees that cover everything. I work for Uncle Sam....and we have a great policy...but having a large employer like that...they can afford it. I pay $200/month for my insurance...the government pays $700/mo for my policy....that's $900/month just for health insurance....that's big bucks for a small business. I know everyone complains about the insurance companies and how tight they are...but they are a business and they are entitled to make a profit...just like we are entitled to get paid when we work. But did you know that the surgeons get $6-8,000 for their 1-2 hour surgery? And the hospitals get $200-500 a day for that bed you sleep in? And the nurses make $30-90 an hour. Then ya have the drugs used and the anethesist and the janitors and the insurances the medical professionals pay (up to $80K a year in liabilty insurance for a surgeon)...the list is endless. And none of this is going to be free to anyone...someone, somewhere is paying for it. So while I hate the fact that there are policies out there that don't cover WLS....I do understand why. It is all a matter of how much the employer can afford for the best policy they can get. It's like cars...some people drive economy cars and some people drive big expensive luxury cars...the more ya pay...the better the car and options. But both cars do the basics...they get ya from point A to point B....like insurance...they all cover the basics...but some have some added benefits based on the money spent.
But my heart goes out to anyone who is not able to have WLS due to insurance companies. Maybe some of those surgeons out there making $600K plus a year would consider doing some pro bono work eh? Maybe those hospitals could cut a break here and there instead of building new hospitals that look like Hiltons?
Good luck with your journey....I hope you find out that your policy covers WLS 
Ruben, I have this insurance. Go to Aetna.com and on the menu on the middle left side of screen, go to "Members & Consumers" and go to "Clinical Policy Bulletin." That will take you to another screen. Look it up alphabetically as "Obesity Surgery" or just go to 0157.
I am going for my consultation today. I will update you.
I have Aetna as my insurance company. Please feel free to read my profile..It describes all I went thru to get approved for RNY surgery. As far as your doctor's appointment I would say KEEP it. If you don't already have documented supervised weight loss attempts by your physician the sooner you start, the better. Please take the other posters advice and READ the clinical policy bulletin 0157 on Aetna's website. They follow this to the letter! If you have documentation and it doesn't specifically include what they want they won't accept it. So, know the policy bulletin, print off a copy, highlight the exact documentation needed in your PCP's progress notes and take it with you to your appt. This was very helpful for my PCP knowing what he needed to say in each note.
Best wishes and please email me w/anything more I can help you with!
Most Active
Recent Topics
OH National Conference tickets are now on sale! Early Bird Tickets are Limited!
Kim Gyurina, OH Staff · 0 replies · 456 views
Kim Gyurina, OH Staff · 0 replies · 456 views
