Question:
Confused about my insurance coverage...

I just switched to Aetna USHC HMO as of 8/1. Previously had Intergroup which will not cover. According to Aetna's website, www.aetna.com, they do cover the surgery. However, they state they will not cover gastroplasty or any stapling of the stomach, but will cover RNY? Also, says they do cover VBG? I would much prefer to have the stomach separated & stapled than just banded as I am a big sweet-eater. I'm confused... isn't the RNY completely different from the VBG? If so, would RNY still be an option? Feel free to check the site and gather all details. Thanks! :)    — Alyssa A. (posted on July 31, 2000)

July 31, 2000
I've got Aetna HMO and they approved me for RNY within 2 weeks with no problem. They needed the usual BMI greater than 40, and I had a couple comorbidities, asthma and arthritis pain, but they never questioned it. And, when the hospital in the plan quit doing the laparoscopic procedure, they even approved for me to go out of plan because there wasn't another in plan hospital doing laparoscopic, even though 2 of the in plan hospitals are doing open RNY. Good luck.
   — Donna G.

July 31, 2000
I have BC/BS and they are the same way. They will not cover my surgery if it mentions stomach stapling, however, they will cover gastric bypass surgery (RNY) which in my opinion seems to be the same as stomach stapling. I am scheduled for Lap/RNY on the 11th of September.
   — Becki S.