Aetna, Florida, Exclusion, considering indiv. policy
Hi all,
I really need any help I can get here as I've been getting very discouraged lately.
My husband started a new job a couple of weeks ago and will have benefits in about 2 1/2 months through Aetna (choice of Open Choice-PPO, Choice POS or HMO) in Florida. So far I am very discouraged. My COBRA (United Healthcare) ran out July 6th and a couple of my doctors aren't in the Aetna network and that is problem #1. It also appears (as usual) that there is a rather large exlusion clause, ending with "... and other services and supplies that are primarily intended to control weight or treat obesity including Morbid Obesity, or for the purpose of weight reduction, regardless of the existence of comorbid conditions." The ironic thing is that there's a whole list of Eating disorder specialists that are covered and alcohol/drug treatment including inpatient services are covered.
The reason I started looking into this early is because I wanted to decided whether I should get coverage on my own, which has proven difficult so far or try to go through my husband's and fight if it came down to it.
-Is it possible to successfully fight an exclusion when the treatment prescribed by a doctor for condition is weight loss related?
-Has anyone dealt with a similar situation with Aetna in Florida?
-Is it worth trying to get a plan on my own, if I can even find someone to insure me? For me to add to his insurance will cost between $74 and $274/month depending on the plan.
-If a surgery is self pay (if I won a small lottery or something) would insurance cover anything after that could somehow be linked to the surgery like gallstones, GERD, ulcers, anemia?
-Is there any other hope of getting it covered somehow?
I have been researching surgery for about two years now and I am still not 100% sure although I am leaning toward banding or vertical sleeve gastrectomy (which seems to never be covered LOL) I am still trying to look at other medically supervised programs but have no idea how I would even begin to pay for it so if the insurance doesn't pan out I'll just resign myself to trying to eat right and exercise and hope it gets better somehow.
Thanks for any help,
Beth