tri care prime or Aetna insuracne

hello everyone, i was wondering if anyone knows what or if Aetna insurance covers any weight loss surgery? also do you know what the pre requirements are? like 6 months supervised diet or anything like that? as of right now i have tri care prime, they cover only bypass or lapband, i was thinking about the sleeve. I may be getting a new job with insurance, i think this new company has Aetna, so my concern is, if i should wait and see what is covered by Aetna or go ahead with tri care prime. once i get the Aetna, then my tri care prime will be my secondary insurance and would be harder to get surgery if Aetna does not cover anything.
i hope thise makes some kind of sense. ha ha
thanks for any help out there
debby

 I just had my lap band surgery on December 20th and I have Aetna PPO Insurance.   Here is a link to their Clinical Policy Bulletin which has the requirements for approval:

http://www.aetna.com/cpb/medical/data/100_199/0157.html

Hope this helps

Pam

Pam, I live in the area. I am too looking to get the lap band done. who was your dr that did the work?

You might want to head over to the Insurance Board. There are several people talking about Tricare. They only cover the sleeve if it is on base... I think that is what they were talking about. An MTF or something similar? Otherwise, they only cover banding and bypass.

Aetna, it totally depends on if your employer bought the WLS rider. Aetna provides WLS, it's up to your employer to pay the premiums for WLS.

Hi!

It depends on what region you are in as far as Tricare  Prime goes. I am in Utah so I am in the western region and they only cover Lap Band or RNY. I was approved very quickly and they required no special diet prior to surgery. They covered EVERYTHING and I had no copay. One mistake I did make, was that I never checked into whether or not they cover any problems in the future. For example, if I needed to have the band removed, Slips, etc... I was so focused on if they would cover the surgery, I didn't think further into the future. So be sure you asks those questions.

Good luck with your decision!
Jen-

Jen-

 
Yep, covered.  Tricare is great for bands or bypass.

did you have a deductable payable to your surgeon? i was told that i had a $612 deductalbe i had to pay to the surgeon, which did not make sense to me with tri care prime, i am down in florida. so i will have to check into this.

i am thinking i will go ahead and have the band with tri care before my new insurance kicks in as i am already approved.
thanks for you help
debby

I have Aetna PPO as well and with my policy , and they are all different , I paid 20% up to a family maximum of 1500.00 for the calender year. I had to do a 3 mos intensive or 6 mos supervised diet and see a physical therapist and psychologist and nutritionist. It took about 3 weeks after my info was sent off to hear anyting but my file got lost. My brother only took about a week and he has Aetna too. A different policy though.
The best ting to do is to call them and ask what your specific policy will and will not cover and go from there. Also might wanna ask your human resource ppl and make sure that there is not a no WLS clause in your policy too.Some companies have those.
Good luck on your journey !