Aetna Problem :( - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Vocley · 03-04-2009, 02:57 PM

My name is David, 18 years old and a college student at Baylor University in Waco TX. I weigh about 450 pounds, and my BMI is around 65. I sometimes have trouble sleeping and on occasions find it difficult to get from one place to another, walking. I have always been obese, since I was 10 years old. I have gone to the doctor several times when i was young, and to a nutritionist, and nothing ever came about. Diets just never worked on me. My aunt and uncle recently got the gastric bypass surgery and they have both individually lost over 100 pounds and they seem much happier. I have recently been looking into surgery and it seems like this is the only way I can become a healthy human being.

Here is the problem. My policy doesn't cover the gastric bypass surgery. I called the number on my card and they flat out told me I was not able to do anything. MY card has the following information on it. "Aetna Global Benefits" PPO, "ITT International Plan"

So here I am, asking you. Hopefully someone who was in my shoes in the past will be able to point me in the right direction. What can I do? Is there some sort of appeal process that I can do? Is there another insurance that I can use?

Help is very much appreciated, thanks.

Native2u · 03-04-2009, 03:14 PM

Have you read the policy yourself? I also have Aetna, but I have "Total Health Plan". If I were you, the very first thing that I'd do is......read your policy and see for yourself what it covers. I found that when I called Aetna, each time I would call (and get a different person), I'd get a completely different answer.

Vocley · 03-04-2009, 03:27 PM

Quote:

Originally Posted by Native2u

Have you read the policy yourself? I also have Aetna, but I have "Total Health Plan". If I were you, the very first thing that I'd do is......read your policy and see for yourself what it covers. I found that when I called Aetna, each time I would call (and get a different person), I'd get a completely different answer.

Where can I read my policy? I looked on the website and can not find anything

Native2u · 03-04-2009, 03:35 PM

Quote:

Originally Posted by Vocley

Where can I read my policy? I looked on the website and can not find anything

Aetna has a website. I'm not sure if this will lead it to your policy or not...but,

www.aetna.com

Vocley · 03-04-2009, 03:46 PM

I just called again, different person.
I told her my situation and I got the same response. The plan I have does not cover gastric bypass surgery. They told me that even if I did meet the necessary requirements for approval, there was nothing I could do.

loki8481 · 03-04-2009, 04:46 PM

that sucks

sounds like there's a specific exclusion in your plan?

I'd imagine your only work-around would be to talk with whoever administers your plan (presumably HR at your employer), find a new health insurance company, or pay out of pocket.

Native2u · 03-04-2009, 08:08 PM

Quote:

Originally Posted by Vocley

I just called again, different person.
I told her my situation and I got the same response. The plan I have does not cover gastric bypass surgery. They told me that even if I did meet the necessary requirements for approval, there was nothing I could do.

Can you change insurance companies? If so, that is what I would do.

GTR-Mark · 03-14-2009, 08:35 AM

I was in the high 300's in college and I remember how hard it was. Stairs at the dorm, walking between buildings at campus, desk size differences, social situations, etc.. If you can't get insurance to pay, think of other alternatives. Don't be afraid to borrow from relatives if that is an option or consider paying for it with additional student loans. Your earning potential will be higher at a lower weight and the surgey will pay itself back in so many ways.

-Mark

JCDancer · 03-14-2009, 08:51 PM

The folks replying here are correct. Don't give up.

1st: Call your HR dept and get direction as to where to get a hard copy of what your insurance plan will pay. If this is under parent(s)' plan ask them to get this info for you. Aetna offers a wide array of health plans. Those that allow you to go in an out-of network etc. Understand your plan.

2nd: The person who said this is correct. The person on the other end of the phone (@ Aetna) is not always right. You want to believe that they would not delibertly say "NO" hoping you wouldn't pursue. It's not right and a book and movie was made about that already. BUT I will say if you don't ask teh correct questions or in the right way, they may say "NO". I had this experience when I was trying to find out if my insurance would cover counseling. I was told 'NO' but I was able to get when it was worded differently.
3rdly: Have you found a reputable doctor? They may have this insurance thing down to a science and be able to help you.

From the various articles etc I have been reading over the past few months, more and more insurance companies are covering this suregry. I was told that it is not considered an elective surgery. They just may be requiring more hoops for you to jump thru (ie tests and weight mgmt care) before approving the surgery.

PUSH FOR THIS! GOOD LUCK!!

birdy36 · 03-15-2009, 10:55 AM

I have Aetna as well, but my plan allows for the gastric bypass.

My employer pays extra to have that service covered. Who carries your insurance? Is it possible that you could convince them to change the plan when it is time to enroll again?