VSG & Aetna Choice POS II Health Insurance

So I am hearing from some that the Gastric Bypass and the Lap Band are normally the 2 surgeries covered by insurance & not so much the Vertical Sleeve. Is this true? Has anyone ever had Aetna Choice POS II and it cover or help cover the VSG? I am not at all interested in the lap band or the gastric bypass.

To find out for sure, call the number on the back of your insurance card.  Insurance varies from plan to plan and state to state, so it's best to call to be sure. 

It can even vary by employer if you're on an employer sponsored plan. Employers can choose to specifically exclude bariatrics altogether. Definitely call the number on your ID card and talk to someone about covered vs. excluded benefits. 

Insurance plans vary by employer.  You'll only know what your plan covers when you call your provider directly.

Contact your insurance provider and speak with a customer service representative.

Also this information might be available on the insurance company's website.

Aetna has, in general, been covering the sleeve since around 2010 when they revised their policy bulletin to include the sleeve along with the bands, bypass and DS (when they cover them - as noted by others, policies chosen by different employers may or may not cover bariatrics.)

You should be able to look up the relevant current policy bulletins on their website and see if they apply to your specific policy (or just call them and check with their rep.)

I even lucked out with them as by the time they got around to actually paying the surgeon, we had hit the max out-of-pocket level for the year and they paid his fee 100% even though he is out of network.

Good luck!

The gastric bypass and band are the oldest of procedures, so they are more widely known. The sleeve has gained a lot of respect in the last 5 years.  The duodenal switch (which is what the sleeve was derived from) is another procedure more available these days.  It's been around since 1988, but only started getting respect for insurance coverage the last decade or so.

The difference?  The sleeve gives a good permanent restriction, and the DS has that restriction and also an intestinal bypass to boost metabolism.

Just call your insurance company and ask them three questions:

1- is WLS covered?

2- What procedures are covered?

3- What do I need to accomplish before applying for pre-approval?

I have that plan and they paid for my LapBand in 2007 and my revision to VSG in 2014. They weren't covering the VSG back when I got my LapBand. That being said, your particular plan may exclude it or have different requirements. You need to call them.

Not to hijack this thread...but how do you like your sleeve compared to band?  I had band removed over a year ago, and it took me this long to get mentally prepared for sleeve.  I want feedback from as many ex bandsters as possible.

Thanks

CJ

My husband has Aetna Choice POS II  -- in our house we say that "POS" stands for "Piece of ****".  Tells you what we think of Aetna these days.  

They told us what my husband needed to do to get approved for surgery -- and he did it all.  Two weeks BEFORE surgery they decided that his high blood pressure wasn't really a co-morbidity because he takes medication that controls it.  So - BOOM! - now we're down to one co-morbidity and he's below 40 BMI and they will no longer approve the surgery.  

We decide to proceed because he's covered under my insurance too and BCBS has signed off on it.  However, for the LAST 9 MONTHS Aetna has refused to issue an EOB for his April 2014 surgery that says the amount of the hospital bill is "patient responsibility".  So when BCBS sees that EOB they refuse to pay too....because the primary says the patient doesn't owe anything so there's nothing for the secondary to pay.  Get it? 

So now the hospital (that I work for!) is holding the bag for a $30,000 surgery that nobody wants to pay for.  And we're bumping up against timely filing in exactly 3 weeks.  After a year you can't submit claims to the insurance company any more.  And all because Aetna won't reissue a god-damned EOB stating that we owe the hospital $30,000 instead of $0.00.  Makes no effin' sense since it's not one dime out of their pocket either way!!

Yeah, have fun with those ********  It's been a hellacious ride the last 9 months.  Make sure you get EVERYTHING documented in WRITING from them.  I had to prove to the *******s that the hospital had submitted a pre-approval because they were denying the claim on that in the beginning rather than the fact that he didn't qualify for surgery based on their rules.  I had to give them a copy of the letter THEY sent to US.  

Go with god my friend, you'll need it