Aetna Insurance Coverage for LapBand to Sleeve

[Wisconsin Girl]

Hi,
I am new to this website. I was banded three years ago, lost only about 40 percent of excess body weight (40 pounds) and still have a BMI of 33. Last week, I couldn't drink and had to have an emergency unfill. I proceeded to then tell my doctor about all my lapband woes: constant throwing up, can't eat chicken, can't eat till night time, etc. etc. He is now encouraging me to have the sleeve. I researched it and it looks like a good option. The only problem is the $$. There is no way I can pay for this out of pocket. I had my original lap band with Blue Cross but am now with Aetna. My doctor thought maybe they could get Aetna to pay because of my problems with the lapband. Anyone have any thoughts/experience with this? By the way, the doctor would not take a fluroscopy or do a fill on me. He just thinks I should leave it open and go to the sleeve...

[MediaHound]

Welcome to the site, WG.
As far as I know, usually they only pay for 1 weight loss surgery in a lifetime (per policy). Since you switched providers you might be ok.
Here's to hoping you get good news.
At worst, if you aren't, you should consider our sponsors/featured surgeons in Mexico if you need to go out of pocket.
Combine their great prices with some financing (or a credit card!) and you should be good to go. Please keep us posted.

[celticmom218]

Aetna wouldn't cover any weight loss surgery. I had to switch to BC/BS.

[msdw59]

Obesity Surgery

Check out the section on repeat surgery. If your band has failed then you may be eligible for wls. Now which procedure is a whole 'nother kettle of fish. But there is a provision there.

Good luck!

[shanna1001]

I have Aetna and they do cover WLS as long as you meet their pre-reqs. They just started coverage about 3-5 months ago. Since your lap band was with BC then Aetna would do your 2nd surgery for sleeve (it's their 1st surgery in their eyes). BUT -- you said your BMI is 33, which Aetna requires a BMI of 35 (with complications like diabetes, heart disease, sleep apnea) and then a 40 BMI if you've been overweight at 40 for over 2 years. Call Aetna and ask if they cover bariatric surgery. That's what I did. They'll then give you a copy of the plan your employer has accepted. It might require additional or less pre-reqs. You can access it on their website too (if you don't want to call). Just go aetna.com and sign-in to your plan and then search for the Clinical Policy Bulletin #0157 for obesity surgery. Good luck to you!

[Wisconsin Girl]

Thanks everyone. Well, I'm not inclined to gain weight to get my BMI high enough to make the qualificiations as if it were a first surgery. Hopefully, they will cover it as a revision. I'll let you know. The surgeon said to expect an answer in a couple of weeks.