Question:
What is Aetna's wording....

Can someone tell me where I can find Aetna's wording for qualifying for WLS? I've been all the way around that site and I can't find anything. I need to know what they want before I qualify. My bmi is 40 and I have Hypertension (treating for 15 yrs) sleep apnea, arthritis in both knees, two herniated discs (L 4 & 5) heel spurs, etc..    — [Anonymous] (posted on May 21, 2001)

May 21, 2001
I have Aetna MCN and you can have a BMI of 35 with comorbids or BMI of 40 or greater. You must also have a minimun of 2 supervised physician diets,along with a diet history of failed diet attempts. I called my husbands employer and spoke with human resources-she mailed me a copy of the requirements(sorry don't have any longer). Also Aetna has a web site(just do a search under Aetna)and it will tell what's required depending on what type of plan it is. Personally, go to the employer and get a copy of what was contractually negotiated and accepted. Good luck. Oh, Aetna approves RNY for the prior info. They don't approve BPD/DS which is what I had unless medically necessary and proven RNY isn't ok for you for whatever reason.
   — Linda M.

May 21, 2001
Aetna was GREAT. Check out my profile for a complete run down of my experience. I really only had one supervised diet per se but no problems at all. Good luck Also, check out www.aetnaushc.com
   — Jeannet

May 21, 2001
Unless you have a stipulation in your companies portion of the contract, you'll get it through Aetna almost certainly. They wording is that they pay for it if it's medically necessary, which your surgeon convinces them of with the letter. With a 40bmi and comorbidities, you're a shoe in!
   — Amy K.

May 21, 2001
Hi, i am researching, too GO TO THIS WEB SITE: http://www.aetnaushc.com/cpb/data/CPBA0157.html someone else had it on theri site, but they misspelled something. This is good!!
   — [Anonymous]