Revision- Aetna

 Okay so I went to my dr's appt to day and I am thoroughly confused about whether my surgery is covered approved or otherwise...... . First I was told by my insurance that no bariatric procedures are covered. Then I speak with human resources and she checks the certificate and it says its not covered unless  by preauthorization, so she says she will check with the Rep and see what is involved in a preauth. Now today I speak wth patient financial services and they tell me my surgery is approved and all I need to do is bring a copy of my post operative surgery report to my visit with the surgeon.....Lastly the she says after that then everything needs to be submitted for predetermination.....soooooo am I approved or not....and if bariatric surgery is not covered under my plan what are they billing the surgery under to get ti approved.......maybe I am missing something.....I have to go see the surgeon on next wednsday so I will get clarification then but has anywon dealt with this? If so I could really use your help....thanks again fam!!


Oh yeah then when I get back to work there is a letter on my desk stating what I was told by my insurance that no bariatric surgery procedure is covered unless there was a complication with the previous bariatric surgery and it affects ones immediate health......I am just alittle confused.....lol

you need to go by your copy of your adhesion contract (subscriber agreement)  in there the exclusions would have to be CLEARLY stated, and what procedures are covered, etc. once you have a good understanding of what is in there and if you still have questions, contact your insurance co,  forget about asking HR or Dr's office etc.

 Thats the problem I have talked to them and it is clear it is not covered, however they have been paying all the claims thus far....dr's visits, nutritionist, psychologist etc...the only exception is if there is a complication with the previous surgery.....thats the reason for my confusion.....I guess once the predetermination comes back that will tell all though!