Hello! Does anyone have this insurance and can divulge more info about criteria/out of pocket expenses during the process? Looking into getting GB but need more info before hand - thanks!

I have Aetna Choice POS II and it paid for everything connected to my bypass three years ago (aside from my annual deductible). They did require six months of a structured weight loss program. I had finished one six months earlier (a last-ditch effort to lose weight), and they counted it even though it wasn't right before surgery.

I would also note that Aetna turned me down the first time and my surgeon had to call them directly before they finally approved me.

Good luck. It's worth it, no matter how long it takes to get approved!

Good afternoon, I have Aetna. I was told that I have to complete 6 months of an approved weight loss plan. I started an approved weight loss plan a couple of months ago, but not sure if it's acceptable or not because it wasn't with a dietician. Prior to consulting with the surgeon, I contacted Aetna directly and asked what were some of the requirements, and what my out of pocket expense would be.

I wish you much success!

Thank you! @ CDMC1972 - did you have a large out of pocket expense? So did you just get your insurance & then meet with the specialist you picked? I’m new to this whole thing and it seems like a lot so I want to get everything together. I wouldn’t be doing any of this until Jan…

You're welcome! I had gastric banding in June 2009, and had it removed last year June. I realized that I wanted to get another WLS in May 2022. So, I called Aetna to see what my out of pocket expense would be. When I had my band removed last year, my total out of pocket cost was $50. I'm not sure the final cost for this surgery, as it will be based on the # of days I will stay at the hospital. I want to get the gastric sleeve, but not sure. My surgeon may recommend gastric bypass, due to the issues I had with the band. I still have concerns about that---I don't know how I feel about rerouting! I chose the same surgeon who did my gastric banding. I set up the appointment in May and I've been completing all of the necessary clearances and pre-op items.

Every Aetna plan is different. Choice POS II is the network, meaning you can see in or out of network providers. If you have coverage through an employer sponsored plan, you need to review the plan details because some employers exclude bariatric surgery. Aetna does require six months of an approved weight loss plan as part of their clinical review-this seems to be standard across the board.

Your best bet is to call Aetna Customer Service directly who can give you the rundown on if it's covered, what is covered, clinical criteria, estimated out of pocket expense, and recommended providers.

Thank you so much for that information! Looks like my plan covers 80% after deductible!

12 hours ago, AmandaD. said:

Thank you so much for that information! Looks like my plan covers 80% after deductible!

You're more than welcome! I wish you much success!!