Aetna Open Access Vs. United Healthcare

[NurseTeresa 0]

Olive, it all depends on what your insurance plans cover. Read your books closely before you make a decision on which insurance company you choose. I have UHC and wls is not included in our policy. So please read carefully to see if it is included or excluded. That may make a difference in the insurance you choose. Best of luck!

[kimmiev 0]

I have Aetna Hmo and have jumped through every hoop and still got denied (I am appealing and going through another 3 months of supervised diet in addition to the 6 months i have already completed!) Aetna denied me because my PCP didn't write that we discussed "behavior modification" in my visit records. He did write diet, exercise, and what diet I was on and prescribed diet pills. I did everything and my policy/employer actually covers the lapband! I still got denied!

I work for United Healthcare... I do know that they cover a lot easier than Aetna does. At Aetna, every case has to be reviewed by the Medical Director. At United Healthcare , it does not. Just call United Healthcare and verify that your employer plan does include coverage for bariatric surgery. Good luck!

[gonnabethin 10]

It all about CARVE OUTS. An insurance company may offer it to a company and the company chooses a cheaper plan based on what is "carved out". just because an insurance company covers it in some doesnt mean they do for all. Its all up to what the employer is paying for and saving money on. Everyone curses the insurance company- its not their problem. Its what the company chooses to cover or not!

Think of it as a turkey. The turkey cost is $20 per person if you carve off the breasts(WLS, PS, other $$$ procedures) then the cost comes down to $8 perperson that is more affordable for the company and the majority of the employees. THAT is how insurance for companies and employees is dealth with.

Hope that helps- its not personal its business. The people are not factored in except for how many in numbers need health insurance. sooo if you want it covered you have to go to the personel/human resources and that will be a fight of fights as you will find. If they make an exception for you they have to do it for everyone. Silence is never kept and they end up losing $$$$.

Good Luck!

I have UHC and have had several versions over the last 5 yrs. Some versions covered some not- Im acting while it is!!

[kimmiev 0]

thanks for your replies.

My employer actually does cover the bariatric surgery. So, at this point it is the insurance company requirements I need to satisfy now. They have told me by phone, that basically, they want my supervised diet to include progress notes that include what type of diet i was put on, what and how much exercise i did, and what behavior modifications were implemented. Behavior modification was the main thing that my PCP didn't mention in my records.

Hopefully, The 3 month supervision I am going through will be enough for Aetna this time. Should be completed with that in November.

Thanks to you all for your help!

[LB927 0]

I did not have any problems with Aetna, which surprised me since I had problems with them when I was doing my IVF treatments/drugs, which they covered, but were being difficult. Like we cover the drugs but only of your Dr. injects them, yeah right, my Dr. is going to open at 8 pm (optimum time) to give me a shot! Finally, they came around and all went well.

I began my LB approval process with Aetna in mid-July and was approved after testing, psych, cardiac etc... on 9/6/06. We have a PPO policy which does not exclude WLS. My out of pocket is $500 and then ins kicks in at 100%. Also, since my fills will be done at the surgery center they are treating these as a procedure and will pay for them. I am scheduled for surgery on 9/28 with Dr. B.

When speaking with Aetna I asked how long the approval process would take and the rep said I would not have any problems getting approved. My husbands company is a large pharma and they have specific Aetna reps that work with the employees (maybe this helped). She did mention that not all policies are written the same and it just depends on what your company selects to cover.

Good luck with your getting your approval. Just be persistent and it will work out.