Aetna is a large, well-known health insurance provider in the US. The company offers a wide range of health insurance policies sold directly to the public and through employer programs. These policies differ from one to the next in the types of coverage they offer, as well as the types of procedures that are not available.
Aetna offers health insurance policies that will cover bariatric surgery. However, like most health insurance companies, they require patients to go through a series of steps to gain qualification and approval for the procedure based on medical testing, psychological testing, and compliance steps.
Factors To Reach Approval
To be approved for bariatric surgery from Aetna, patients will need to work through the organization’s clinical policy. This looks at:
The medical necessity of the procedure
Proof that other weight loss attempts have been taken and failed
The type of procedure the surgeon is recommending
A patient’s overall safety to survive surgery
A psychological test to evaluate readiness for a lifestyle change
The precertification process for obesity surgery from Aetna can take several weeks to several months to complete, with most people expecting the process to require about six months from initial consultation to approval. Once your doctor submits all of the necessary forms, the procedure may then be reviewed, and ultimately, the insurance company will approve or deny it within three weeks.
There are situations where you may be able to request that the process be expedited. For that to happen, your doctor would need to file an emergent need for the procedure with documentation proving it is the best solution for the patient and why.
It is critical, then, to know what your bariatric surgeon’s goals and expectations are. In many situations, their approval is the first step.
