Question:
Should I call Aetna to see if there is an exclusion?

I have heard of there being exclusions depending on your employer. I called Aetna a long time ago and they said that AETNA covers WLS surgery. But, I am wondering if my employer's policy specifically has an exclusion. They acted like all Aetna covers it. Does this seem right?    — emilyfink (posted on April 24, 2002)

April 24, 2002
Hi Emily! <p> I have </b>Aetna U.S. Healthcare, MC</b>. When I inquired about whether or not weight loss surgery was covered, I was told that if I met Aetna's requirements, that the surgery would be covered at 100%. <p> The requirements that I needed to meet are: <p> - Weigh at least 100# overweight, BMI of 40 or more. - Comprehensive diet history, with weight losses/gains. - Letter of necessity from my PCP, including co-morbs. - Letter from my surgeon explaining the benefits of WLS. <p> All insurance companies are different. I started my WLS journey in October of 2001 and am scheduled for surgery on May 15, 2002. Because I had such a long time to wait, it gave me the opportunity to get all the paperwork completed, specialists and testing out of the way, letters from my surgeon and PCP as well as documentation on my diet history etc. <p> <i>I hope that this helps you. Feel free to e-mail me with any questions!</i> <p> Good Luck and God Bless!!!
   — Anna M.

April 24, 2002
Ask your employer for a copy of your policy. It actually should have been provided to you at the time your insurance went into effect. If you look under the part listed 'exclusions' It will state if it is excluded. Usually it will state something like surgical treatment for obesity is not covered, but treatment for morbid obesity is. It is the ins companies way of preventing someone from getting this surgery that only has 20lbs to lose.
   — RebeccaP

April 24, 2002
Aetna's policy is quoted correctly below. However, your employer could have an exclusion. You should get a copy from your employer.
   — Julie S.

April 24, 2002
I have Aetna US Healthcare MCN and originally my husbands policy didn't cover it(altho Aetna did). It wasn't until contract radification that it was added on 01-01-01. It depends on the contract and what was negotiated! Find out from your Benefits Coordinator or HR person what the policy covers. Yes, Aetna covers this surgery but if it's not contractual then they don't. Best wishes on this journey.
   — Linda M.