AETNA coverage

Im wanting to know if anyone knows if Aetan covers revision?If so how hard is it to deal with them?My husband just got this Ins,and i have looked over his book,but its alittle confusing.TY for the help...

You'll have to call, I think. I had Aetna when I had my original RNY and I remember that there was a lot of information on their website. Try that.

Good luck,

Lynda

Depending on the policy it will be covered. I have heard that some policy's state one surgery/lifetime.
My policy threw work does cover the sugery.
Some people have posted this which is found on Aenta's website
Aetna's Clinical Policy Bulletin (CPB) # 157 Obesity Surgery: 

1. Repeat Bariatric Surgery:
2. Aetna considers medically necessary surgery to correct complications from bariatric surgery, such as obstruction or stricture.
3. Aetna considers repeat bariatric surgery medically necessary for members whose initial bariatric surgery was medically necessary (i.e., who met medical necessity criteria for their initial bariatric surgery), and who meet either of the following medical necessity criteria:
4. Conversion to a RYGB or BPD/DS may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure; or

5. Revision of a primary bariatric surgery procedure that has failed due to dilation of the gastric pouch is considered medically necessary if the primary procedure was successful in inducing weight loss prior to the pouch dilation, and the member has been compliant with a prescribed nutrition and exercise program following the procedure.
   
   I am currently working with them on getting pre certification for a revision. It is becoming a headache because the Dr. office is not sending the correct information and then are SLOW!
   Good luck, your best bet is to call the 800# you have on the back of the card and talk to a customer service person for info.

Just an FYI, I also have Aetna and have been quite frustrated with their customer service.  I am also in the process of going through the hoops to get pre-certified for a revision.  The part you copy/ pasted of the policy bulletin is correct- but it appears that revision patients may also be required to complete all of the steps even for first time patients.

Thus, I had a PCP visit yesterday to officially document my current weight, and collect the last 2 years of weight history along with medical information relevant to having a revision.  Fortunately, he has offered to write me a letter to support the medical necessity of this revision.

Then, today I had an Upper GI done which was really a request of the surgeon's office so he would know what he was looking at prior to surgery.  It came out with extreme inflammation in my esphagus and stoma opening which is caused by the problems I have with eating any sort of dense foods.

Next week I have a Nut appointment and the first appt for a Psych eval.  Evidently, they want a full psych eval, so am thinking I may have to go back for another visit to do testing demonstrating my mental stability.  I guess talking to me isn't sufficient. 

I also will be submitting documentation of exercise for the past 6 months. 

After becoming so frustrated with the Aetna customer service to ask them what documentation I needed to provide to submit for a pre-cert, I asked for a supervisor.  All she could tell me is to submit as much information as possible.  What frustrates me is these insurance companies cry about how much "we" cost the insurance companies and here they are basically encouraging me to run around and see all these professionals when it really might not be necessary/ appropriate.  I kept hearing from everyone, "we don't process the claims, so we can't tell you what you need to do, we can only tell you what your policy covers or doesn't cover".

Here is the icing on the cake.  The supervisor tells me that if I don't submit enough or the right type of information, I can always appeal.  Yeah, that's exactly what I want to do.  I have nothing else to do with my time.  I'm like, tell me what they need to see- and quit hiding behind all the legal jargon of their policies.

So, I will continue spending their money, taking time off work, paying co-pays....  whatever, playing the game.  They want documentation, I will FLOOD them with documentation.

Id like to thank everyone very much for your information,and il be looking though everything everyone suggested:)

I have Aetna and I had no problem getting my revision to RNY approved.  My surgeon submitted a letter with all of the issues I was having with the band, even though I was completely compliant.   It was deemed medically necessary to remove the band.  My approval came pretty quickly and I didn't have to do any of the previous workups.  My insurance is the federal policy, but I don't think the bariatric rules are any different.

Deb

I think the answer depends on who you talk to. The pre-cert department has their own staff and separate phone number. But if you call member services, some will say only the repeat surgery portion applies. Other will say the whole kit and kaboodle. That has been my experience. I think the only way to be sure is to have your Dr. submit to pre-cert. Some doctors won't until you have certain things accomplished. Others are just going to jerk you around until they've shaken out every last penny like my original surgeon. Good luck!