Aetna Open Access Plus Plan...Anyone??

[lilbit08 0]

:smile2: Ok...So I was so excited because I was scheduled for my consult on 12/4 with my current insurance of Cigna's Open Access Plus Plan. This is my very 1st step in starting the whole weight loss process. A while back when I called them they told me that WLS was excluded unless medically necessary and I have a BMI of 49.1 so I am thinking that I was going to be ok.

Well I get to work on Monday to get an email from HR that our insurance as of 1-09' is going to be changed to Aetna's Open Access Plus Plan. I called the Dr's ofc and they moved my consult day to 1/6 because the scheduler stated there was no reason for me to come in on 12/4 and they try to get approval thru Cigna when in January it is changing. Just wondering if anyone has ever used or known anyone to have Aetna's Open Access Plus Plan pay for the lapband? If so, Please let me know the process! Thanks bunches!:wink2:

[MacMadame 81]

Aetna's bariatric policy is on their web site so you can look up the details. They do pay for lap band if your BMI is over 40 and you go through a 3 or 6 month program. However, your company has to include WLS in their coverage. If your company excludes it, then you are hosed.

[smellyfresh 0]

I have Aetna Open Access they do require medical records for the past 2 years showing obesity. A six month diet and exercise program through your doctor, 3 months have to be consecuetive (sp) in the last 2 years. Lower BMI's require co-morbidities.

Here is a link to the policy

Obesity Surgery

As long as your employer did not exclude the surgery you should have good luck.

Personally, It took less that 1 week for me to be approved for my surgery, but I knew the requirements, and had done everything on the list, except the surgeons required pre-op tests & nutrition, before we submitted.

Julie

[lilbit08 0]

Aetna's bariatric policy is on their web site so you can look up the details. They do pay for lap band if your BMI is over 40 and you go through a 3 or 6 month program. However, your company has to include WLS in their coverage. If your company excludes it, then you are hosed.

Hi there! Thanks for the reply. MY BMI is 49.1 but I am not sure that the policy is going to cover me. I have my consult on 1/6 and I was told that the Dr ofc that I am using is good about trying to get approval, so we will see. How would I know come Jan if my job's policy totally excludes wls?

[lilbit08 0]

I have Aetna Open Access they do require medical records for the past 2 years showing obesity. A six month diet and exercise program through your doctor, 3 months have to be consecuetive (sp) in the last 2 years. Lower BMI's require co-morbidities.

Here is a link to the policy

Obesity Surgery

As long as your employer did not exclude the surgery you should have good luck.

Personally, It took less that 1 week for me to be approved for my surgery, but I knew the requirements, and had done everything on the list, except the surgeons required pre-op tests & nutrition, before we submitted.

Julie

Sent u a private message. Thanks!

[Lady Lap Band 71]

My policy covers up to 90% which I think is the most they will cover for anyone

[Persona363 0]

I have a BMI of 35, how stringent are they with the co-morbidity? Do they consider metabolic syndrome a co-morbidity? Thanks in advance.

[Lady Lap Band 71]

I was wrong everyone! My husband just changed our Aetna plan and now they cover 100% so they do cover it all! Oh and as of 3/9 I was told by Aetna that my surgery is approved by them! I am so thrilled! Per their website aetna considers the following comorbidities

1. Coronary heart disease; or
   
2. Type 2 diabetes mellitus; or
   
3. Clinically significant obstructive sleep apnea (i.e., patient meets the criteria for treatment of obstructive sleep apnea set forth in Aetna CPB 004 - Obstructive Sleep Apnea); or
   
4. Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management);
   

[Mona40 0]

I have Aetna Open Access and my bmi is 41.5 and I was approval within 4 business days. I was scared because of my last 2 years bmi. I guess Aetna didn't have a problem with it. Make sure to check with your HR to make sure that lapband is cover. If so you want have any problems long as your following Aetna requirements. Good luck:thumbup:

[Jodi73 11]

My bmi dropped down around 4 years ago, but was 40+ the last two yrs. That is making me nervous too! It makes me feel better knowing you were approved quickly! Mine will not be submitted for three months, so....

By the way, did you have to do the three month or six month diet, and what are the factors there?

Jodi:rolleyes2:

[La Gordita 0]

Hello i would like to chat with concerning how you got your Ok for surgery i am concerned that if i do lose wt the 3mth diet before surgery they will say no. I have heard i have to lose and that if I lose to much they will say no. So please let me know what you think please