Aetna coverage

Hello, I am new here and looking for some advice. I have done a lot of research on WLS and have found mixed responses. My parents have Aetna (I'm not exactly sure what kind) and I was wondering if you think I would be insured. I am turning 20 at the end of the month & my BMI is somewhere between 41-44 (not sure of my exact weight or height). I have tried loosing weight in the past, but not by a "group" like Weigh****chers. I have tried many dvd programs and have been active all my life. I swam competitively from ages 4-17 (as well as tennis, lacrosse, volleyball....)and now go to the gym at my university, but my weight was always an issue. Do you think that is enough proof for the insurance company to show that I have tried loosing weight in the past? I don't have any other "conditions" unless you count my back and feet pain that I have had for the past few years

I am going to a seminar this Thursday at what could be my surgeons office & I hope to gather more information. Right now I'm just looking for opinions if you think I could be covered.

Valerie

Hello Vallerie -

I have Aetna insurance (Aetna PPO) and they do cover WLS.  You need to check with your parents as to whether their plan specificlly covers WLS.  Som companies have an exclusion to WLS. 

If it is covered, then there are requirements that you must follow in order to get approved.  You need to have a 6 month supervised diet by your personal care physician.  This means going in once a month and weighing in and documenting with your PCP. 

If you look on www.aetna.com and type in 0157 in the search, it will bring up the clinical bulletin that shows the specific requirements.

Good Luck!
Nan
 

Hi Valerie,
I also had Aetna for a while. The first type would not pay for any out of network surgery (so I was out for a whole year) The next year I took the high Option Aetna and they wanted me to go to a hospital in center city Philadelphia, after a 6 month diet. I was able to switch my plan to Keystone HMO (a blue cross plan) and I was approved right away and I am having surgery next Monday. It seems that any blue cross plan is eager to pay for the surgery, so if you have a choice in NJ, stick to blue cross. As far as your weight goes, as long as you are greater than 40 BMI, you don't need any comorbities to qualify.

 i don't know what kind of aetna i have though since it is my dad's insurance. i will try to ask around & figure it out though. one doctor's office has actually contacted me & said they could fax over paperwork to fill out to see if i would be covered before i go into a consultation. i definitely need to do that & soon to get the ball rolling. i just have trouble picking up the phone.


just out of curiosity, if you don't mind me asking, did you go for gastric or lap band? & what made you decide one over the other. i have a long way to go, but i'm still debating between the two....
thank you for the response though. & good luck!

Valerie,
I exactly what you mean about picking up the phone. I work the night shift(7p-7a) and I was on the computer one night and went to Barix web site and just filled out the on line questionnaire. They called me and made all the arrangements for me, I just had to show up.

As far as my choice, I did go to an information consultation (about 10 People), back in May 2008. After listening to Dr Boe and a few of the others who were there after a lap band had failed them and now they were there to receive the gastric bypass, I thought why waste the time and money on something that could fail. I do work with a women who I told I was going for the surgery and she said "You know I had the Lap band" which I didn't. She said she was smaller than when she started, but she was no pleased with the results. I think you have to be very careful what you eat with the band. And I know I am not careful or I would'nt need this surgery in the first place. Check with other people for their reasons they choose one over the other. Take Care Pat K.

 thanks for the reply! i just saw my physician today & she started me on the 6 month plan before i go an see the surgeon. it was really hard to pick up the phone & call, but once i did it i felt happy. she supports me & thinks that having surgery will really help. now i just have to wait & see what happens....

i think i am leaning more towards gastric now after hearing some stuff about lap band. it seems that in the long run you don't get as much weight loss & there are many more doctors visits....

thanks!
Valerie

Valerie -
I had Aetna PPO when I had the surgery - I was approved after my first letter from the surgeon - I did document quite a few attempts at weight loss, including groups like WW and diets like Medifast, etc. But, if you can document diets you have tried and how much you lost and gained back - you should be all set. Especially if your Primary Care supports you.

I consulted with my surgeon BEFORE the 6 month supervised diet and saw his nutritionist and psychologist and attended his support group - and was able to listen to many people discuss their lapband and rny experiences. It was VERY helpful in deciding to have rny - for many of the reasons you mentioned - but also because it seemed to me to be a long term solution to keep the weight off.

Make sure the surgeon you are considering is IN network - all I paid for surgery was $25 copay for office visits pre and post-op and a few dollars here and there for labwork. The actual surgery didn't cost a dime out of pocket.

Good for you getting this under control so young - I wish I had done this 20 years ago!

If there is anything else you want to know, feel free to send me a PM and I will do my best to help you out.

Best of luck to you! Diane

thanks! i found my surgeon through a search with Aetna. it was a while ago but i do recall getting on their website & who was covered with my parent's insurance. they sent me to a page with a huge list of WLS people but anytime i tried to search for them online nothing came up. i was just about to give up when i was able to get an actual site for the guy i'm seeing now. the site was so professional & thorough i didn't have anymore fears.

just last week i went to another one of his seminars (first one was in january) to see if it was still right for me. i think he was a bit surprised at how in depth my questions were & that i took it seriously.

for a while i have felt like i was either too young or wasn't heavy enough to get approved. i actually had a friend in high school who had gastric bypass when she was 18 so i don't know why i worried about that. even at last week's seminar the guest speaker who is also a patient told us that she had lap band at 24 & was around 220 pounds.

i'm going to try to set up my personal consolation with him so i can hopefully meet with him before the end of the year. since my birthday is 2 days after christmas it would be an awesome present to myself to get the ball rolling.

thanks for everyone's helpful & kind words! i hope to be able to get everything organized this winter break so that i can set a surgery date for May which is the end of next semester....

wish me luck!
and thanks again!


Valerie