Aetna Requirement for WLS
Aetna covers most types of weight loss surgery, but because differences can exist from policy to policy, you need to check your individual policy for specifics. For example, most Aetna HMO plans and Aetna QPOS plans will exclude coverage for obesity-related surgical procedures unless Aetna improves the surgery individually. It will be important for you to contact Aetna directly so that you can determine whether or not your individual policy covers the weight loss surgery you want to have.
Requirements for Pre-Approval from Aetna
Aetna has coverage requirements for adults and adolescents. For adults who are aged 18 years and older, you need to be categorized as severely obese for at least 24 months and this obesity needs to be documented well by your physicians. According to Aetna, severe obesity is defined as:
Surgeries Aetna Covers for Weight Loss
Surgeries Aetna Doesn’t Cover for Weight Loss
The following medical procedures are not currently covered by Aetna:
Some Aetna policies will require that you use an in-network provider for your weight loss surgery, but this is not always the case. Using an in-network provider will generally reduce the out-of-pocket expenses that you need to pay. Your individual insurance policy will help guide you to find the right provider for this procedure, so make sure that you contact Aetna to determine the best place to undergo your weight loss surgery for the best results and a good price.