Aetna PPO or United Health Care EPO???

Hi All! Hope everyone's having a great day! I currently have Aetna US Healthcare through my employer. As it stands right now, my surgeon won't submit the paperwork to Aetna until I have completed a 6 month doctor supervised diet. She insists Aetna will not approve the surgery without this, although I was not informed of this when I called Aetna and asked them about my requirements for approval. That being said as of January 1st, the insurance my employer will be offering is changing. The only two choices I will be allowed to select from will be Aetna PPO (POS II), or United Health Care EPO. In general, which policy do you think would be the better choice for me? Any advice you might have would be greatly appreciated Take care, Cathy

You should do two things right now. 1. have him submitt anyway and get denied. 2. find out which plan if either covers the surgery, because UHC primarily excludes the surgery. Aetna has requirements but they may go to an exclusion as well. Personally I like Aetna, they cave on appeal. As for number 1, the reason I say make him apply and get denied is that god forbid your plan goes to a total exclusion in 2005 you have a denial from 2004 to appeal. So if you get denied now, and you find out as of 1/1/05 both new plans exclude the surgery, you can appeal this denial which was made when this dumb requirement was in effect. You're surgeon should know that with pushing, Aetna caves. It's better then trying to fight an exclusion. Good luck Gary www.obesitylawyers.com

Thanks for your help Gary. Have a great weekend! Cathy

I had Aetna ppo when I was going through my approval process and had to have the 6mo diet and also 5year weight documented. When I had all the requirements filled .. my comments on Aetna...I was overall happy and didnt really have a problem..I didnt try to jump through hoops and just filled what was required from them. sent packet on 12-31- 03 never made it to the case nurse it was supposed too. resent it 2 weeks later, And was approved Feb 17 04 good luck! Shauna proximal 5/11/04 229 pre-op 146 now 125 goal

Hello Cathy, I use to work for Aetna up until May of this year. I would advise for you to go to www.aetna.com., from there you would look to the left of the screen and there would be a tab that says members and consumers. put your cursor on that and scroll down to clinical policy bullentins and select medical. Continue from that page and then select the category for alphabetical order. Select O and the first link will be obesity surgery. You would be able to read the requirements in black and white from there. Aetna has an exclusion that is written there saying a supervised diet from and physician OR 3 months supervised diet from the surgeon performing the surgery. The 3 month diet is what my surgeon has done with the majority of his patients. As far as out of pocket expense and EPO plan would probably be cheeper, depending on your coverage under PPO. I currently have AETNA PPO, but I have changeg it for January to EPO because of this reason. If you have any questions feel free to ask. I hope this information helps you.

do the six months supervised diet and use uhc. i heard aetna is very hard to get approval. sheena