is this possible ? Aetna

This sounds like a stupid question to me but this is what I'm experiencing with Aetna HMO. Is it possible that the Medical group that has to approve your referral has different criteria than the actual insurance company..?? On Aetna Website I read BMI over 40 for 2 years.. My medical group is requiring over 50 BMI for 5 years..... Thanks...

It's absolutely possible. I have Aetna but my plan is self funded meaning Aetna is just the 3rd party administrator. My employer "follows Aetna guidelines" but they can, as my medical group, call the shots. 

Also, the 2 year criteria is new. You might want to mention it to your benefits coordinator at your doctor's office and see what they say. I had to point it out to mine. He hadn't heard. He said insurance companies don't inform them of changes. It's up to us to find out.

I agree with Kim. I would say about a month and half ago (approx.) that criteria changed. I was always checking to make sure I had everything covered and noticed it. This seems to me as a positive change on Aetna's part.

Monica

Thank you all for responding... I thought it was nuts but now at least I know it is possible.... Have a super week :)