Aetna PPO - Thyroid Condition exclusion - Help?

deedee21573
on 10/15/10 10:35 am - Oklahoma City, OK
I am hoping to have surgery soon after the new year. I currently have an HMO that does not cover WLS at all and am switching to the Aetna PPO plan which does offer it with all the hoops to jump through. I was pretty excited until I read today in the policy that you can not have an endocrine or thyroid condition.

Well...2 months ago I was diagnosed with Hoshimoto's Thyroiditis. Given meds and will go back to see the Dr. in 3 months. I have been morbidly obese since at least 17 when at my lowest remembered weight of 217. In 20 years I have gained 200 lbs. I am certain it has nothing to do with my thyroid but now I am super freaked out wondering if they are going to deny me based on this. What can I do? I can't convince my Dr. I don't have this condition...

Has anyone else had to face this hurdle?
Kelli S.
on 10/18/10 10:29 am - Kalamazoo, MI
WAIT A MINUTE!!!! I have Aetna PPO and no were on my policy coverage information does it say this. I have hypothyroidism.

I am 27 years old, 5' and 3/4" tall. HW: 263 SW: 226 LW: 142 CW: 198

deedee21573
on 10/18/10 12:16 pm - Oklahoma City, OK
Maybe our policies are different. That wording is the last bullet point in mine under all the loop holes you have to jump through to have surgery. I still don't know what to do about it. I am going to try to get the Dr. to write a letter to explain that the symptom of "modest weight gain" due to MH does NOT apply to me. I am really worried. Meeting with one Dr. tomorrow. Not meeting with the endocrinologist till Dec 1. I am also going to order MR as far back as 7 1/2 yrs ago to show it is no fluke thing. Fingers crossed I can convince them.
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