Every heard of this???

I have Aetna insurance.  Surgery is covered at 80% with a $2K maximum out of pocket.  Just today, I found out that bariatric surgery is only covered at 50% with no out of pocket maximum!  If you follow doctor supervised nutrition and exercise for two years after the surgery, then they give you the remaining 30%.   Here's the kicker--you have to stay at the same company and be continuously covered by this Aetna plan.  How likely is that?  I work at Tyco, which is being split into 3 different companies and is doing lay offs every 6 months!!  This sucks!

Is that all of Aetna, or just your policy?

Talk to your employer.  Tyco's US Surgical is the largest supplier of bariatric equipment, along with Ethicon.   So limiting bariatric coverage is ridiculous.

You bring up a good point about US Surgical.  I will follow up with HR on that point.   Gary, I do have one other question for you.  Tyco's current Aetna contract is negotiated for Tyco as a whole, and they have stated that the Tyco policy will remain unchanged in 2007.  However, in 2008, the contract with Aetna will be renegotiated because we will be a new company, well 3 new companies.  The Aetna policy states that you must be covered unders that same plan for two years in order to get the remainin 30% for the surgery.  Based on the company split, it will be impossible to remain on the same insurance plan or contract.  Is this a legal issue?  Basically there is no way to fulfill the requirements so Aetna is not required to pay the remaining money.  Do I have a leg to stand on?

Well, I checked with Aetna and my employer, and basically it is what it is.  In order to have the surgery, I have to pay 50% of the negotiated rate.  This amounts to about $10k.  I've decided to move forward anyway.  i increased my medical spending account to $5K and then we'll pay $5K out of pocket.  It's a lot of money to spend, but I'm worth it!