Aetna Choice POSII ???

I have Aetne Choice POS II?? Any one have any ideas about it is it hard to get approved?? Any info?

I have Aetna Choice POS II.  First of all, you need to make sure that your specific benefit package includes weight loss surgery. Even though Aetna covers surgery, there are many companies that have "exclusions" in the benefits that they purchase from Aetna. The companies get less-expensive coverage for employees if they purchase insurance plans that cover everything except certain procedures. And unfortunately, there are many companies that exclude "weight loss surgery" in their employee coverage. (It's like buying home insurance that excludes "flood coverage".) So even though Aetna offers weight loss surgery coverage, it doesn't mean that your company has purchased it. So check your benefit details carefully, and check with your company's Human Resources department. And call Aetna, they should be able to see all the details about what your workplace has purchased. Secondly, you need to do everything required. Aetna is strict about that. You must have doctor records that show your BMI above 40 for at least 5 years. You must then participate in either (1)a 6-month physician-supervised weight-loss program or (2)a 3-month "surgical prep" program that is supervised by your surgeon or a physician and that includes meeting with a nutritionist, and an exercise specialist and a therapist (if you have any psychological conditions). The entire process must be carefully documented and dated by doctors. (They don't accept weigh****chers or other similar programs because it must be supervised by a physician). But as long as you follow these rules, my understanding is that they ARE really good about approving--and fast. However, from what I've read, they can be really difficult about allowing any exceptions to their rules. For more information, you can see Aetna's official policy here: http://www.aetna.com/cpb/medical/data/100_199/0157.html I would also recommend that you check out this section of Obesity Help:  http://www.obesityhelp.com/morbidobesity/members/insurers.ph p If you click on your state, it takes you to "ratings" for different insurance companies based on the experiences of other users of this site who have tried to get approval for weight loss surgery. Good luck! 

Thank you! I checked and it is covered if the doctor precertified? If not it may only pau 50 -65% if precertifed they pay 85%? What is the precertifed anout? Also will it matter if I live in Oklahoma and the Doctor I am thinking of using is in Texas?

Sounds good! You're one of the fortunate! Precertification just means that the doctor must get approval before the surgery. (He/she can't perform the surgery first, and then send them all the proof that you met the requirements.) All of your medical records, etc should be sent to them before the doctor can be precertified. They'll need time to review everything. Your doctor should be fairly familiar with the process. I don't believe that it matters if you travel to Texas, as long as the surgeon and the hospital are both in Aetna's network. Actually, that reminds me of something else you need to check. You must make sure that both the surgeon and the hospital are in network. Aetna has the annoying problem of having a lot of doctors in their network--even though the hospital where the doctor works is not in their network. If you're just seeing the doctor for a check-up, it doesn't matter. But for surgery, the hospital has a LOT of expensive claims that they will be submitting as well (anesthesia, medication, a room and bed, etc...) And even if the surgeon is in Aetna, they won't pay for the hospital bill unless the hospital is in their network as well. Some surgeons work in more than one hospital...and they'll do the surgery in whichever hospital is in the patient's network.

Thank you  I am glad I had not thought of that than u so much for your help I really appreciate it. God I am glad I found this site I really feel better about my decision to go ahead with this the more information I have the more I feel comfortable. I am going to call Mon. and Ask about ins. then make a apt. and get started I am so excited!!!

I have AETNA PPO and have been denied but am working on the appeal.  My surgeons office has be wonderful with helping do the submittal and arranging the appeal.  If you can I would really recommend taking advantage of their experience and expertise.  Good LUCK!