Aetna no longer covering surgery :(

So I spoke to Aetna today (I have Standard POS) they said regardless of my plan with Aetna - meaning even if I went Deluxe POS, they simply are no longer covering the surgery - at least in the state of NJ I guess. I was also told by our HR outsourcing company that Oxford and GHI are also no longer covering this surgery no matter how badly you need it. I heard that some people were actually gaining more weight in order go get the procedure done. How odd is that? I'm so depressed. I wish I had done this two years ago. No wonder the best surgeons in my county no longer accept Aetna, because Aetna doesn't even cover it  

Ally-

I realize each plan is a little different but this is contrary to the new CPB issued September 8, 2006 by Aetna.  You might want to check into the matter a little further.  You can find the new CPB at the following: http://www.aetna.com/cpb/data/CPBA0157.html Red

Dont believe what they tell you on the phone.  Aetna does cover it, they just deny as many people as possible to get people to walk away  Keep pressing them.  You can also go to the State for an appeal if it is not a self funded plan

OK, I found out what happened. My company uses an outsourced HR company called Gevity. Gevity has written something into the policy stating that they will no longer cover any obesity surgeries as well as assistance with infertility. How sad is that? So some day if I get a new job, I may have a second chance, with my luck, by then nobody will cover this surgery :(

I called Gevity asking them what the situation was because I was told by a Biatric Clinic that Aetna does cover LAP band surgery. Gevity specifically told me that to keep the costs down for their clients, they have written in two exclusions recently, one being weight loss procedures and the other being the infertility assistance. I wonder if one can sue? I wouldn't have the means to, so I will most likely just look for another job. I was also told that GHI and Oxford are not OKaying this surgery.

I am not sure about GHI, but  I used to work with Oxford and have a contact who is a project manager in the member services department.  According to him, Oxford has not put a blanket exclusion to weight-loss surgery.  Most exclusions are engendered by the employer; of course, Oxford simply administers them. Regarding suing of a company's attempt to mitigate costs, in this country, you can just about sue for anything.  However, cost mitigation is nothing new; health insurance companies in conjuction with their customers (employers) do it all the time.  If they did not, then basically anything could be theoretically covered.  But, then again, health care costs would be rising exponentially more quickly than they are now. Just to make a point:  there are some employer groups who purchase a rider for gender-reassignment surgery (mainly through Health Net of California).  Of course, 90% of employers don't pay for that extra rider.  In most cases, if the employer is willing to pay, the insurance company will be willing to administer.