Cash Pay

Hello all

I am BMI of 37, with AETNA, and without the specified co-morbidities -  I have pre-diabetes and not diabetes, I have high cholesterol which responds to high levels of medication (not refractory as required), I have GERD (not on the list) , and over the past year put on the 15 lbs  that put me over the 35 BMI.   I'm afraid I won't be covered, so I'm saving pennies etc in case I need to cash pay.

My question - if I cash pay, will insurance cover any complications of the surgery?
 

Hi,

It sounds like you will be denied, unfortunately, because Aetna is very specific about meeting those requirements in order for them to approve the surgery.  I have Aetna and myself and my three children were all approved, although we all had BMI's of well over 40 so we did not have to prove the specified co-morbidies. 

I am sorry I don't know the answer to your questions, but I would be very curious as to the answer!  Have you tried calling their Customer Service and asking?

Good Luck to you!
Nan

Hi Nan
Thank you for the reply.  Of course, I called customer service, and they referred me to the published information.  While I'm doing the 3 month diet etc, my doc is having me go to the cardiologist etc in advance of submitting, just to make sure I don't have anything going on that my PCP wasn't aware of.  My PCP is very good, so I don't think they'll find any thing.
Thanks
Eliza

While I didn't have any complications to test it out, I was told that no complications would be covered. It made me wonder what could be tied as a complication and for how long, say 5 years down the road I have a hernia, will they try to blame it on this, etc. That was my biggest fear but to date hasn't been tested.