Anyone covered by Aetna with a written exclusion?

I live in Seattle and I'm hoping to get this covered... anyone have an experience with this that they'd share with me? Good or bad... Also, we are self-insured if that makes a difference. Meaning, if I was to appeal, it would go in front of our own review board. Thanks for any information... Brenna

Oh, one other thing... I have not yet decided on a procedure but was rather leaning towards a lap band or if that's not possible, a lap RNY.

Brenna, The very first step is to call the Aetna number on your insurance card and ask the question "Is medically necessary weight loss surgery a covered procedure?" There are some companies (self-insured or not) that specifically exclude weight loss surgery. The only way to know is to call. If it IS covered then they will refer you to this web page: http://www.aetna.com/cpb/data/CPBA0157.html This is the web page spelling out the official Aetna policy on weight loss surgery. Since I just went through this I can summarize: 1. Medical history showing obesity over the last 5 years 2. BMI over 40 or BMI over 35 with other medical problems 3. A six-month medically supervised diet OR a three month behavior modification program including diet, excercise, and therapy. If you find out it is covered, go to your primary care Doctor NOW - tell him what your trying to do and start documenting everything. Make sure they record you weights and progress. I only got my approval 4 weeks ago and I still have 6 weeks until my surgery. Hope this helps. Wizard Dan

I know it's not covered, there is a written exclusion in our policy. However, I have been advised by several people not to let that stop me and that I should be able to get it approved anyway. Fortunately, I have been going to the same doctor for years and I have all my weight loss attempts documented (and there have been many). I also have a BMI of 52 and Weigh****chers booklets with over a year of stamps in them. Plus a few co-morbidities. I'm hoping I will be good to go, with maybe an appeal or two. Thanks so much for the website and information, and good luck with your surgery! You almost look familiar, do you work downtown by any chance? Brenna

Um... make that 58. =(

Hi Wizard Dan! Congrats on your surgery date! I have my surgery in 13 days!!! Good luck and see you on the losing side!!!

Brenna, go ahead and try, its definitely not going to hurt anything. But Dan has spelled it out pretty clear. Those are the exact same steps I had to take recently, I was approved for my surgery about a month ago and its scheduled for May 24th. I wish you lots of luck in your journey! Hugs, Tina