Out of network approvals

AETNA has no surgeons listed in their network in this area, has anyone very gotten approval for an out of network surgery and not had to pay the penalty?

Sue, Did you call Aetna? I called and gave them the hosp. that I thought they would approve. I'm so glad they did. I really worry about Aetna. I'm hearing such horror stories about them. I am trying to get all the info. they will want plus have been going to Phy. weight loss plus my Dr. stuff, and I worry it just won't be enough. What is the closest in-network hosp and Dr. near you. We in the Akron Cleve. area seem to be surrounded by them.. Good Luck and God bless Judy

Have you checked under regular surgeons. I would call them and ask. My surgeon (but I did not use Aetna) is not listed as a Bariatric surgeon but as a general one. Just a thought here.

You can go to Aetna's web page and look up General Surgeons in your area. Some of them may do the bariatric surgery. Unless they are in a specific bariatric hospital (such as Bariatric Treatment Center), many are referred to as general surgeons. I have Aetna and I went to BTC which was completely out of network for me - hospital, surgeon, all of it. However, Aetna did come through and paid all but 1,500 out of a total of almost 60,000 bill. I don't know why or how, but I'm not asking any questions. I went into surgery expecting to pay 10,000 or so out of pocket (my 30% of reasonable and customary charges for out of network coverage PLUS the difference between what was billed and R&C), but it turned out much better than I had expected. Good Luck.