Kaiser or Aetna?

The company I work for (hope to be made an offer soon, Im a contractor right now) has Kaiser and a variety of Aetna plans. I want to get a VSG or D-Switch. Which has people had success with? I'm really excited about landing this job and having insurance to cover the procedure. I know that Aetna plans usually have a 3 month documented diet with a physician and kaiser has a documented 6 month plan, thus I'm leaning towards Aetna PPO. Plus my Dr has worked with them a lot and know all the in's and out's with them.

I have Aetna PPO and had my DS 3-13-09.  I've also had complications.

I've  only had to pay a small fraction of what it would have cost without insurance (around 5 grand out of pocket instead of a hundred grand or more for everything).  I had 2 hospital stays split over 2 plan years thanks to bad timing on my part.  If everything happened in one plan year it would have cost even less.  (above numbers do not include my monthly plan premiums)

As long as you follow their written steps (policy guidelines), getting approved was relatively easy compared to many of the others I've read about here.   The guidelines were readily available for printout on the Aetna website.

I would suggest that you ask for tips via posting here on getting approved whichever plan you choose.  Knowing what has worked for others in the same plan definitely makes getting approved easier.

Good Luck!

You've asked this (or similar) before, and it seemes you've either not come back to read or have ignored the responses.

ALL AETNA PLANS HAVE THE WLS REQUIREMENTS. The PPO, the HMO, the Aetna Circus Clown Plan, whatever - they ALL have the same requirements for WLS: your choice of 3-month multidisciplinary weight loss plan OR 6-month doctor-supervised diet (among basic requirements like 40+ BMI or 35+ BMI with comorbidities, etc.).

Also, if you're still with Dr. Schweitzer, he's not doing the DS in one step anymore, so you'll get a VSG alone whether you want it or not for at least a year before doing the switch part, and then, insurance will likely only cover it if you qualify for a revision.

Aetna does NOT typically cover a VSG (nor a 2-stage DS), as they consider it experimental/investigational, so if that is what you want, be prepared to appeal.

Finally, yes, Aetna will cover WLS - but ONLY if your employer has purchased the rider! What you need to do is get copies of the actual policies from your HR department and ensure none of them have a specific WLS exclusion. Many people have Aetna plans that exclude WLS, and they are SOL!

If you want VSG or DS, I wouldn't mess with Kaiser. With them, you're looking at multiple appeals because they try so hard to keep you with their in-network surgeons and hospitals, who do not perform the DS at all.