ins exclusion - Page 2 - ThinnerTimes

JenBear7 · 04-10-2007, 08:50 AM

Ask for a copy of your specific coverage. They have to send it if you ask for it (at least they do here).. .then read the exclusion yourself. Baron may be onto something.. and HE has been fighting this for a LONG time!

LoriAnn925 · 04-10-2007, 09:53 AM

There are some things that are pretty standard for getting approval for WLS if your insurance covers it and the 6 mo physician monitored diet (not Weight watchers or Jenny Craig) is at the top of the list. You really can't go wrong with getting the 6 month diet out of the way.

Generally its not the insurance company that excludes the surgery. Generally is an exclusion that the company who gives you your beneifts has added on to the policy. Its not Aetna that excludes the coverage, its the employer. They do this to save money on the premiums. So, while there is an exclusion on your policy, Aetna itself does not exclude weight loss surgery. Unfortunately that's probably why you keep getting different answers. Because Aetna does cover the surgery, however your policy doesn't. Make sure when you're asking, that they look at YOUR specific beneifts and aren't talking in generalities. Hopefully your husband's company will change insurance this year, and won't add another exclusion on. Like Jen said, you should request a copy of your coverage, so you can see it in writing.

Good Luck. I hope it works out for you.

Miss Kitty · 04-10-2007, 09:58 AM

And this is why i paid cash for my surgery. Yikes!

raquel · 04-10-2007, 10:04 AM

Well I have a copy on the way of my specific plan. I really don't think I will ever get around it this year with this plan. The main things that bother me is hca blaims aetna and aetna blames hca. I really believe/know it is hca. And HCA should know how important wls is and how far it has come. Also in their defense hca does offer humana and wls is covered. Unfortanatly I got the wrong info on the phone and on line or I would have chose humana to start with. Now I know better. Unfortantly they can't quote an ins policy that hasn't been written yet for the next year. No matter what it is it will most likely need a 6 month dr supervised diet and I think I can get that out of the way.

The last person I talked with said there is nothing at all saying that the surgery is covered if I do this or that. I just don't know how to get them to look between the line when there aren't any.

Also my mother really did hurt my feelings.

mauldinmama · 04-10-2007, 10:05 AM

My insurance had an exclusion...they said you had to have a bmi of 40 or higher..or 35-39 with health issues...
Now my cousin's husband who works for BMW...they completely wrote off wls and will not approve it.
So when I started my wls journey I looked over my husbands insurance book and it said wls surgery excluded UNLESS you have bmi of 40 and above or 35-39 with health issue's.
So after I read that I called and asked for there requirements and I was on my way!

PLEASE DONT GIVE UP! Maybe you just didn't have all the information they need!
My wls office have been extremely supportive and they have all the different insurance information down as to who requires what...they can be a big help..because they are ON your side.

Good LUCK...

raquel · 04-10-2007, 10:05 AM

Quote:

Originally Posted by Miss Kitty

And this is why i paid cash for my surgery. Yikes!

not all of us have that option

momto4 · 04-10-2007, 10:08 AM

I have Aetna as well ~ and my surgery was completely covered ~ I know they have LOTS of different plans ~ but you can choose yOUR plan ~ so cant you just change to a plan that does cover it? You may pay a bit more ~ but nothing in comparison to the total cost of the surgery ~ ...PM me if I can help at all ~ maybe details of my plan may help since it is Aetna as well???

Miss Kitty · 04-10-2007, 10:24 AM

Sorry Raquel that you have to go through so much just to learn that a door is slammed in your face. I'm also sad for you to hear the things your mom has said to you. It does seem like you have some good determination though and I think you will find a way to get this done! I am thankful that I had a way to pay for this myself and also to make my own decisions about my health. Hang in there and don't give up on having surgery! I've seen so many others hang in there and finally they get what they want for their health.

hummingbird5953 · 04-10-2007, 11:36 AM

Quote:

Originally Posted by Miss Kitty

Sorry Raquel that you have to go through so much just to learn that a door is slammed in your face. I'm also sad for you to hear the things your mom has said to you. It does seem like you have some good determination though and I think you will find a way to get this done! I am thankful that I had a way to pay for this myself and also to make my own decisions about my health. Hang in there and don't give up on having surgery! I've seen so many others hang in there and finally they get what they want for their health.

Just wondering...if you pay for your surgery yourself and then have complications, will your insurance company pick those costs up? I was under the impression that if the surgery was excluded then any complications arising from the surgery would also be denied and, if you get unlucky and have alot of problems, that could get pricey.

Miss Kitty · 04-10-2007, 11:41 AM

I don't have health insurance at all. I bet you are right though. My husband works in the family business and they've chosen not to have health insurance. Stupid decision, I think!