I am so pissed!!!

I had a consultation with Dr. Brader a couple of weeks ago.  I've talked myself into the fact that I need this and Dr. Brader was just the man to do it.  I started doing the legwork for a five year history and I found out that Aetna covers WLS 100%, but only in the network!!!  Barix is not in the network!!!!  I am so pissed!!!!  Now I have to start all over.

Sonny

Sonny, All of your effort so far may not be wasted, but applied to another doc’s requirements. Philly? Checkout- http://www.einsteinbariatrics.com/ or- http://bariatric.templehealth.org/content/home.asp There’s also- David Wernsing and Mathew Kirkland at Pennsylvania Health System - Bariatrics A lot of the “hoops” you’ve already jumped through may just transfer straight over… Hope it works out for you. Best Wishes- Dx

 

Hey Sonny, This may be a blessing in disguise. (Forgive me, but I'm not on very good terms with Barix any longer). Barix seems to be closing its clinics down one by one. They have already closed two. I had my surgery in Wylie, Tx, the clinic was shut down when I was only two months post-op. I lost my doc, nut, support group all at once. Although I can't say for certain this will happen, but it has happened, and may happen again.   Don't worry about finding another doctor, just locate one that's in your network and do some research on him/her.  Aetna pays 100% for WLS???? A lot of us guys would have loved to have this problem. Some guys are still fighting with insurance just to get a portion paid. Count your lucky stars my friend. Years from now you'll look back on this and think it was not that big of a deal. I'm sure of it. Good Luck.

Sonny, I'm sorry to hear about the insurance sanfu.  The requirements that Barix has are probably also very similar to what other surgeons are requiring.  So, this may only be a minor setback.  It might be worth calling Aetna to ask what surgeons are in your network.  They may also be able to give you a list of requirements. Keep at it Sonny.  You will eventually succeed.

Thanks guys.  Hopefully my head won't explode. Sonny

Sonny I have AETNA and they do pay 100% or very close to it..  If you go into the AETNA website you can find what doctors are in the network.  If Barix is not in the network there may be a good reason for it.  This is just a little bump in the road so keep moving ahead.  Dan

I feel your pain man! I know it's a hassle, but it shouldnt be that bad. In fact if you really like your surgeon, get him to recomend someone to you, it might speed things along, and will give you a much shorter list to look through! That said, this is a major thing, so how much will they cover if your out of network? I chose to pay extra for out of network because i believe in my surgeon and his team and wanted him to do it. It was a extra $500, but thats a small price to pay really, and they went out of their way to make sure that everything else was done in network. Anyway, call the doctors office and let them guide you, I bet it doesnt set you back much at all! Good luck, and keep us posted.

If I go to an Aetna network provider they'll pay 100%, outside of the network they'll pay 0%.  I guess I'll look "within" the network..  Thanks for all your encouragement. Sonny

I used Dr Rapier at U of Penn.  He's great and so is his team.  His nutritionists are first rate.  My only problem is that I live in Jersey and hate driving into Philly.  Otherwise, everything about his operation is first rate.