I need insurance help NOW!

I am So aggrevated! When my Dr.s office first contacted my AETNA ins. {end of Oct.} co, Bariatric surgery was possible. They forwarded a form including a list of requirements needed for pre approval. At the time, i was also being treated for a gyn prob. had a minor surgery on Dec. 2 and needed a 4 week follow up for gyn. clearance. Got All of my appoints done in Jan. Sent everything Aetna required , all 21 pages, on Feb 18. One weeek later, my Dr. gets a call that that particular coverage is no longer a part of my coverage under the health paln my company negotiated for. I have the same plan, policy number etc.. The only changes that were told to me were the amt of perscription cost, copay etc. I did get a form to appeal it. Has anyone had this problem.

My understanding is that it is each employer's individual policy with the insurance co. that determines whether or not WLS is excluded or covered. If it's an exclusion, there seems to be little chance of successful appeal, from what I've read of other people's posts on this. Do you know (or perhaps you could find out) the date that the newly negotiated contract goes into effect? If your paperwork was submitted prior to that date maybe there will be a chance for appeal. Sorry to post such a "downer".... but it never hurts to appeal it, you never know if there is some loophole or something. Also you should get a copy of the actual contract for coverage from your employer (the insur. co. wouldn't give it to you). That would spell out any specific exclusions, and if it's not in there as an exclusion, you might have a shot. Good luck!

Christine, To add to what Marie said, I would contact my company's benefits administrator. They may be able to purchase a Rider to your benefits to get this covered for you. Not sure if it is cheaper than the surgery costs or not, though. The squeaky wheel gets the grease! It can't hurt to ask! Good Luck! Fran

If you are a represented employee(union) seek out your union benefit coordinator. I have not gotten the same answer twice from the csrs at aetna on the same day on the same question ever no mater what the the topic. ex my daughter was on the table about to have her wisdom teeth out all prearraged by the oral surgeon in his office when a rep from aetna called it off stateing that it wasnt covered in the office. the anestisia was dripping. sort of like the governor make a reprieve. he did my older daughter a year before. a in vestigation, oops, a mistake, its covered, rescheadule, prescribe pain meds and wait two month for her to come back from college, dont take aetna work litely,,have them write down if you like what they say, and keep after them if you dont. i work for telco.