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Baratric surgery and Aetna insurance, what do I need to gualify for Aetna PPO to cover my surgery

By March 23, 2010 - 12:52pm
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does anybody know how long you have to buy the insurance for them to cover the gastric sleeve??

February 7, 2014 - 10:00pm
Guide (reply to Anonymous)

Hello Anonymous,

Contact your insurance provider.

Speak with a customer service representative, who should be able to tell you if there is a wait period from when you purchase the policy to when you can have the surgery and be covered.

This information might be available on the insurance company's website.
Look up your insurance plan, check what procedures are covered, and if there are any restrictions.


February 11, 2014 - 5:26pm


Thanks for your question.

Unfortunately, some insurance companies will not cover a surgical procedure such as Lap Band (or Bariatric surgery) and there is nothing we as patients can do about it. I did find this site that will help you figure out if and how much your insurance will cover if you choose to have bariatric surgery performed. http://www.lapband.obeseinfo.com/lap-band-insurance.htm

It does list insurance companies that will cover partial or complete surgery costs but Aetna is not listed as one.

I also found a forum with others interested in Aetna's approach to surgery coverage and many say that with Aetna POS, they will cover 90% of surgery ONLY after a 3-6 month disciplinary approach has been completed-- meaning: They will ask you to diet for 3-6 months before considering you a candidate for bariatric surgery coverage. http://www.lapbandtalk.com/f8/aetna-insurance-questions-help-please-64509/

I hope this helps a bit. I know Insurance Companies can certainly give you the runaround when it comes to coverage, especially when it is a surgical procedure.
Good Luck!

March 23, 2010 - 1:07pm
(reply to Rosa Cabrera RN)

This is incorrect. Aetna does cover Gastric Bypass. And Lapband. You have to be overweight with a BMI of more than 40. You also have to do 6 months weigh ins and show you are willin to lose weight. If your not with a bmi of 40 you have to have sleep apnea, high blood pressure or diabetes to qualify. You also must be 18 years of age as well for it to be approved.

December 15, 2010 - 2:55am
EmpowHER Guest
Anonymous (reply to celticbeauty)

I agree. I have Aetna and it fully covered my lapband

May 24, 2012 - 4:53pm
EmpowHER Guest
Anonymous (reply to Anonymous)

does it matter what group plan your under? We have the Aetna Choice POS II. I am wanting to have the gastric sleeve done. But, if they will cover the bypass quicker than the sleeve. I am willing to go that route. We were just a couple weeks ago with United Health Care and my husband's job decided to switch. I have already gone through the hoops for the requirements of UHC to approve it. I am wondering if I will have to go through it again. I just completed the requirements two weeks ago. I have Severe Sleep Apnea and stop breathing 144 times in one night. I now sleep with a CPAP. I have a BMI of 40 (at least) I am 5'6" and 246 lbs. My goal is to loose 100lbs. Someone give me some advice. I was devastated when I got the new insurance cards (didn't know that we had different coverage). My Dr. Office was just submitting the documents for the past 7 months of diet and rigorous things I have had to go through. I have high blood Pressure, and they even had to stop my stress test due to my BP going sky high. I contact Aetna and the lady I spoke with was real quick to say No Aetna doesn't pay for any bariatric surgeries. I was devasted and went into a FIT !!!

July 8, 2012 - 4:51pm
(reply to Anonymous)

I do not know why it said I was Anonymous... I just posted this lengthy inquiry. Email me or you can text to 214 704 0339 email is [email protected] I am that desperate

July 8, 2012 - 4:56pm
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