Aetna Limitations and Exclusions

I have Aetna PPO Max and would like to know if RNY is covered.  My plan says" "Weight control services including surgical procedures, medical treatments, weight control/loss programs: food Supplement: or exercise programs"  are not covered.  I have called 3 times and gotten three different answers. Yes, becuase its medically necessary. No they never cover any weight loss surgery. This person must have been new. Their website has RNY requirements for surgery. Or maybe one rep told me You have to contact you PCM. okay I'm afraid if i consult my doctor and they dont cover it and i get new insurance that covers it I would be denied for pre existing condition. Is that true it i consult with a Dr will it be considered pre existing condition. Has anybody has this plan and been approved?  Also what was your cost shares at 70%?

They should mail out a disclaimer to all member with there insurance card that says... EVERYONE'S POLICY IS DIFFERENT, DONT EVER ASK THE QUESTION DOES ANYONE ELSE HAVE THIS POLICY TO FIND OUT IF SOMETHING IS COVERED.... I'm not trying to be rude because i know insurance is confusing but, i cant tell you how many times i have to say this to people. Even if you have the same employer you may have chosen a different plan. So having said that it sounds as though surgery is not covered under you're policy but you can certainly goto you're primary care dr and have them get some more information for you... pre-existing conditions... Most likely if you have a group policy there arent pre-x on you're policy but for something to be considered pre-x it would have to be something you were treated for before you had this policy and as long as you didnt have a break in coverage before this policy started you wouldnt have to worry about it anyway. Hope that helped a little my advice, goto you primary dr and get more information.

"Weight control services including surgical procedures, medical treatments, weight control/loss programs: food Supplement: or exercise programs"  are not covered Medically necessary or not, does not matter in this case as it is an exclusion on your plan.  The insurance company may cover surgery for other groups if the employer chose to include it, your employer has elected not to cover it. If you go to another insurance company, pre-existing will not apply, it will only apply if you had a lapse in coverage more than 60 days.

What Brynezz (sorry if that's not exactly right) said. I WORK for Aetna, have for 15 years, and I'm going to have to go to Mexico for my surgery, if that tells you all anything.  Also, you better believe our insurance is NOT free. 

Your right Aetna will not cover it.  Not sure why reps tell people different things. Thank you for the responses.