[ragon437]

Hi My wife has a serious of medical issues and its only 45. These issues are due in big part to her overweight problem, After the initial seminar she received a call that our AETNA HMO ( we live in Miami-Dade) refuses to pay for the procedure. I called and they said they don't cover it even if its medically needed. We need help. We have two college age sons and two at home and we can not pay for the surgery. Any suggestions on how to get the insurance to pay? Our primary is a great supporter and wants the surgery for the benefit of my wife's health. I truly would appreciate any suggestions. THANKS!

[nursesrock]

If your Aetna plan doesn't offer the surgery, then that's pretty much it from them. They contract with companies/plans/individuals and decide ahead of time what it covered and what isn't. I have Aetna, and it was covered in my plan, but unfortunately not all plans are the same. You could try a supplemental plan that might cover it. Some folks go over the border for surgery at a huge discount, and there are loans you can get for surgery. Unfortunately at this point, it's not like heart bypass that a surgeon can state is medically essential. Before deciding that you can't take out a loan for surgery, I'd take into consideration what mecications, doctor visits, and all that food costs your family. It's an indulgence that I think is worth it. Good luck!

[pretty woman]

Craig T, founder of this site, wrote a book about insurance and WLS. I am sure
you can find a link to it on this site.
I know that some employers contract insurance companies and will decide up front what they won't allow...so while Aetna will cover it for company A, it won't cover it for company B.
I hope you work out a way for your wife to have it. I wish I did it sooner.
Good luck!!