3 month rash requirement w/ Aetna???

I have a friend who's lost over 150lbs on his own, down from 480lbs. He needs a panniculectomy, I checked his policy with Aetna and it says it's covered if the pannus hangs at or below the pubic area...which it does hang below...and have 3 months documented treatment for rashes without resolution. Which he has had some skin issues, but self managed them, I told him today to call PCP and get a script. But my question is does Aetna ever accept the various other issues the excess skin causes...like back pain, balance, exercise and other ADL issues??? Hello, rash isn't the only issue.

No, Aetna ONLY considers the things you mentioned (how low it hangs and history of skin issues).  In fact, their policy specifically indicates that it does NOT consider back pain to be a proven result of excess skin.  I cannot say if they do or do not consider the ADL issues.  I subnmitted a personal letter along with my doctor's letter but have no idea whether they considered the other issues or not since I met the two specified criteria.

Your friend should start trying prescription creams/powders ASAP because Aetna is a stickler about the minimum of 3 months and will also require that he try at least two different prescription methods to treat the skin issues (which they won't tell you up front).

Lora

He's been approved.