Does aetna health insurance cover gastric bypass surgery?

If that provider doesn’t think the request should be approved, a different Aetna Better Health of California provider will review the information. You and your provider will get a letter stating whether the service has been approved or denied. We will make a decision within 5 business days, or 72 hours for urgent care.

How long does it take for insurance to approve weight loss surgery?

It can take two to four weeks for the insurance company to respond with a decision.

Why did Aetna deny my claim?

If your health or disability benefits have been denied, Aetna may have claimed the following: The procedure is merely cosmetic and not medically necessary. The treating physician is out of network or out of plan. The claim filed was for a medical condition that isn’t authorized or covered.

What happens if a preauthorization or precertification is denied?

If a provider fails to authorize treatment prior to providing services to a patient and payment is denied by the insurance company, then the provider may be obligated to absorb the cost of treatment, and no payment is due from the patient. … Others send the unpaid bill to the patient, but doing so is bad business.

Is it hard to get approved for gastric sleeve?

The minimum requirements to qualify for gastric sleeve surgery include: A body mass index (BMI) of 40 or more, OR. A BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, and many others.27 nov. 2020

Is it hard to get approved for weight loss surgery?

Learn your body mass index You typically qualify for bariatric surgery if you have a BMI of 35-39, with specific significant health problems like Type 2 diabetes, sleep apnea or high blood pressure. A BMI of 40 or higher also is a qualifying factor.

What can disqualify you from bariatric surgery?

  1. ongoing drug or alcohol addiction.
  2. uncontrolled mental illness.
  3. significant eating disorder.
  4. an unwillingness to comply with the necessary guidelines following bariatric surgery.

What is the time limit for filing Aetna claims?

Most providers have 120 days from the date of service to file a claim.

How do I know if my insurance covers a procedure?

  1. Read your plan’s coverage paperwork.
  2. Call your health insurance company’s customer service department.
  3. Figuring out how much you will have to pay.
  4. Exact cost estimates are hard to come by!
  5. Appealing coverage decisions.

Can you submit an Aetna claim online?

Providers can file claims with Aetna Better Health ® of California online or through the mail.

What happens if a prior authorization is denied?

If you believe that your prior authorization was incorrectly denied, submit an appeal. Appeals are the most successful when your doctor deems your treatment is medically necessary or there was a clerical error leading to your coverage denial. … If that doesn’t work, your doctor may still be able to help you.

What can I do if my insurance is denied medication?

  1. Ask your doctor to request an “exception” based on medical necessity.
  2. Ask your doctor if a different medicine – one that is covered – will work for you.
  3. Pay for the medicine yourself.
  4. File a formal, written appeal.

What do you do when health insurance refuses to pay?

If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. You can ask that your insurance company reconsider its decision. Insurers have to tell you why they’ve denied your claim or ended your coverage.

Why you should not have bariatric surgery?

Bariatric patients have more psychopathology than the general population even before surgery, and Goodpaster says they have higher rates of depression and past suicide attempts, which are a major risk factor for suicide.

How much do you have to weigh to get gastric sleeve?

To be eligible for bariatric surgery, you must be between 16 and 70 years of age (with some exceptions) and morbidly obese (weighing at least 100 pounds over your ideal body weight and having a BMI of 40).

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