Aetna... is there no hope?

When I started researching WLS from all accounts I read that Aetna covers it. I have Aetna Choice II POS and when I called they said it was not covered in my plan. I didn't ask anymore questions because that really caught me of gaurd and I didn't want to deal with it at that time. The insurance is through Securitas Security in Connecticut and I am wondering if it is the employer that has the exclusion. Is there no way that I can do anything to change their mind. Has anyone ever been in this situation. Hopefully I will find a job soon and get it through my employer but I don't know if I want to change a good insurance plan(no PCP required, no refferals, out of network coverage)  to a mediocre one just for WLS.

Your employer chooses not to buy the rider for WLS.  Change to a different plan that covers WLS and change back to your POS after surgery.

Hi Cristina, Thanks for the response that is the same thing that happened to me, I purchased Personal Choice on my own as a secondary insurance and am hoping that they will cover it.  I should know by the end of next week and I will let you know, then maybe you can do the same. Good Luck, Cindy

I have Aetna HMO Select and WLS is covered under the general surgical benefit.  So it really depends on the plan your employer selected.  Before selecting which insurance you want, as the HR rep what plans they have and get the benefits phone #.  Then give them a call and ask if WLS is a covered benefit.

You do have to see if you employer covers WLS.  Below is the link to Aetna's clinical policy on WLS.  Employers can have an exclusion of course.  I cannot stess enough that you should not take the person's word from Aetna that you do not have coverage.  Get the policy in writing, make sure it is your policy, and understand what it says. My experience is that most of the people I talked to on the phone did not know what they were tallking about.  Jim Randall http://www.aetna.com/cpb/medical/data/100_199/0157.html

Hi, I also have aetna pos II.  My husband is employed be Wal-Mart Distribution Center here in florida.  It is excluded by wal-mart to cover anything to do with weight loss.  I heard from someone at my husbands job that another woman who works there is having weight loss surgery done and that her cardiologist has referred her for the surgery.  I told the man that gave me this info. that I have called our benefits hotline and read it in our benefits book and even checked online and also called aetna themselves and even if it was medically ness. was told it wouldn't be covered.  I decided to just call a bariatric surgeon and ask if they would be able to get my insurance to approve it and was even told no.  So, I said well you know you always get different answers with different people and last week I again called the same bariatric surgeons office and asked again if aetna pos II would cover it even though I knew it was excluded and this time was told that if it was medically ness. then maybe wal-mart would pick up what they call a rider and have this covered.  So, throughout this whole process I have learned not to give up after having asked the same questions a time or two.  Keep asking.  I think what really got the woman to give me this answer is that I looked through my aetna directory book ( has names, and numbers, and addresses ) to see what was listed under general surgeons, dieticians, internal medicines, etc. and I noticed that the bariatric sureon that I had called was listed under surgeons (I knew he was only bariatric surgeon).  So I looked under dieticians and there was only 1 dietician and I was like if this isn't covered then why is this dietician listed and the bariatric surgeon that only does weight loss surgery????? Next, I looked at the addresses of the bariatric surgeon and it happens to be where there are a bunch of suites so I thought about the health problems I have and I knew I needed to see a cardiologist, gastroenterologist, internal med. doc.....  So you know with the aetna pos II you don't need referrals (Thank God!!) so I looked to see out of all these different lists of specialists who was located at the same building as the bariatric surgeon.  I have appointments scheduled to be seen by the internal medicine doctor which is in the same bldg. as the bariatric surgeon so maybe I'll get lucky and be referred!!!!  Hope that helps!