Can anyone tell me their requirement/approval process with Aetna Select or HMO? Thanks in advance

Thank you Jersrose43. I will look into it for sure.

And if you're rudeness and attitude is trying to help, trust me, I do not need your help "pal".

I just wanted to say please don't get upset when someone doesn't understand your situation. Only you know what you have done and what you are doing. I had a hysterectomy in 2012 and diagnosed with hypothyroidism and I have dieted, I have taken prescription medication, I have joined a gym and given up all the foods I was told to by my PCP who has been so understanding and has told me I needed the surgery. I could not pay the cash price with two kids in college and one in high school so I just kept trying and my weight would drop 10 lbs only to go up 7 lbs and then drop 2 and then gain 15 doing the same thing. This was so hard on me physically and mentally. I fought with my insurance who has a exclusion by my employer and I started saving for a trip to Mexico. My doctor told me my weight had been going up and down around 12 lbs for 18 months no matter what I had tried. People think you are lazy or have no self discipline or you are depressed or have repressed some childhood trauma or just given up. I never gave up and finally my husband was offered a new job with more money and insurance that would cover the surgery and he is so supportive and never questioned changing jobs to give me what I needed. Please don't give up and keep taking care of yourself and let the negative people go. I have seen some people talk about a doctor in Texas, Dr. Kim who has a cash price of 4900 dollars I think. I am not sure what that covers and what the hospital would require but it might be worth looking into for sure. Good luck and Best wishes.

ImageUploadedByBariatricPal1436805828.219098.jpg

I wonder if this works.

No reputable surgeon should do that. A lot of medical offices now have a paragraph in their welcome packet that says we do not code or bill to get something paid; we code and bill what was done; please do not ask us to do otherwise.

Occasionally a patient will ask me to change a code. I pull out their medical record and if the requested item is not there, it will not happen. For instance, if muscle strain is covered but fibromyalgia is not covered, I won't put muscle strain on their claim if muscle strain is not actually documented by the doctor in their medical record. The treatment may even be exactly the same, but we still will not do it.

If a patient then says, "well my other doctor does it", I offer to put them in touch with the Medical Board, the Office of the Inspector General, the Medicare Fraud Unit (whichever is applicable in their situation). That usually ends the conversation.

Msgal2181: Thank you for the kind words. I will be scheduling my consult with a highly recommended bariatric surgeon here in my area. My husband and I agreed to go ahead and pay cash for it rather than switching insurances to one that we aren't comfortable with. This has been the only road block with our insurance we have ever faced. It has been great for us and our kids. I'm blessed to be able to pay for the surgery in cash as I know many aren't able to. Now I'm wondering what the wait time will be prior to surgery since I don't have to worry about the insurance requirements. So I will count my blessings there. Again, thank you for your kindness.

Edited July 14, 201511 yr by Smj481

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I'm so sorry that your insurance does not cover bariatric surgery. I know that must have been devastating for you to learn, especially after getting your hopes up.

If my insurance hadn't covered it I would never have been able to afford it on my own. I'm holding out hope that some day soon the insurance industry will come around on the WLS issue, so that more people will have a chance at a healthier life.

I hope you get your chance some day too!

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I'm so sorry that your insurance does not cover bariatric surgery. I know that must have been devastating for you to learn, especially after getting your hopes up.

If my insurance hadn't covered it I would never have been able to afford it on my own. I'm holding out hope that some day soon the insurance industry will come around on the WLS issue, so that more people will have a chance at a healthier life.

I hope you get your chance some day too!

It's not the industry that has the issue. It's your employer

They choose what riders to have. And if they are self funded they can write whatever policy they want.

You will find that plans you get from non self insured employers tend to cover it.

We need to talk to the benefits people at employers. They need to understand the cost of long term weight are way worse than a $10-30k surgery. That's the employers negotiated insurance price by the way. Charges can be crazy but insurance doesn't pay that

I could not and was not going to jump through hoops for Aetna. I'm going to self pay and be done. I'm just so over Aetna!!!

I don't have a hernia.

You may have a hiatal hernia and not know it, I had one tha discovered during my WLS.....you would need an endoscopy to find out.

Edited July 15, 201511 yr by Chele H

I could not and was not going to jump through hoops for Aetna. I'm going to self pay and be done. I'm just so over Aetna!!!

I'm self pay too. My consult is next Friday. His office said I should be able to have surgery by the 2nd week in August so I'm super excited. Good luck on your journey as well