Question:
Complication from prior surgery but employer no longer covers.

I had RNY in 2002 and my insurance, Aetna, covered everything. I have been having pain and tests show that I have a tear in the pouch. Problem is my employer no longer covers WLS. I don't understand since the doctor takes Aetna. Shouldn't a repair be covered?    — Tawnda C. (posted on October 9, 2007)

October 9, 2007
I wouldn't think a repair would be WLS. I would say it is more of a medical problem. I would file a complaint and see what happens
   — muffin1837

October 9, 2007
I hated Aetna when I had it. They denied me WLS and I weighed 465 pounds. So I switched insurances. I know that may not be an option for you (switching). Seems like your problem would be covered, it is not WLS. Best WIshes, Mick
   — MCraig3

October 9, 2007
I have Christian Brothers insurance through work and I applied for WLS and just days after I sent in my application, I got a letter and so did everyone saying that they would no longer cover WLS. I was panicked, but I wrote and wrote and said that I had applied when it was covered and finally a board agreed to cover 50%. I had the surgery, but now they won't pay for anything! They are not paying to see the doctor or blood work...nothing. I challenge everything. My blood work started way before surgery. Hang in there and keep trying. Insurance companies have to wake up and realize that in the long run WLS saves them big money. They were paying for 9 meds before and I am down to one now. Come on! Good luck with your search.
   — cmancl

October 10, 2007
I was told before my surgery that if your insurance covers the surgery they have to cover any complication resulting from it. I would fight this! Actually your Dr should be fighting it for you. Good luck I'll keep you in my prayers.
   — Joanna J.

October 10, 2007
Hi there, I had to fight to get my surgery covered because my insurance had and obesity exclusion. Contact ObesityLaw.com They are wonderful people and can possibly give you some advice. They are the ones who got me approved. Good Luck, Pam
   — Pam_B_OR

October 10, 2007
Hi, I have Aetna also. What you need to do is call a DR. who specializes in Gastroenterology. That way you won't be going because of your gastric, but because of your stomach problem. I am almost 100 % positive you will be covered that way. Aetna categorizes the proceedures differently. Give it a try and let me know.. God Bless and Good Luck, Pam
   — Pamela C.