Does Aetna Cover Gastric Sleeve Surgery?
Yes, Aetna Health of California will cover your Gastric Sleeve Surgery as long as your insurance plan's requirements for gastric weight loss surgery are met. Each Aetna California insurance policy can vary on what weight management or bariatric and gastric surgery expenses are covered or excluded, so it may be easier to have our Gastric Sleeve Insurance Coordinators verify your Aetna Gastric Sleeve Surgery coverage for you. Simply give us a call at 1-855-200-8041 or fill out our FREE Gastric Sleeve Insurance Verification Form! Verifying your Gastric Sleeve coverage is hassle-free with no obligation. Even if you don't meet your insurance policy's requirements, we can send a letter of medical necessity, request an individual need assessment and help you through the appeal process if necessary.
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Aetna Gastric Sleeve Coverage
Every person is different, and so is each insurance plan; Aetna Health of California’s Gastric Sleeve Coverage and pre-approval requirements vary with every insurance policy and potential patient. Part of determining if Aetna covers gastric sleeve surgery, per Aetna Clinical Policy Bulletin 0157, all patients must have a minimum of 2 years documented medical history of morbid obesity and at least 3 months of medically supervised non-surgical exercise, dietary and lifestyle modification treatment and a psychological evaluation if indicated by their physician.
A Body Mass Index (BMI) of 35 or greater along with a written letter detailing all prior attempts at weight loss programs, including diet and exercise, over the last 5 years may be required by Aetna prior to covering any bariatric procedure. You may also be required to undergo a 6 month supervised diet (nutrition evaluation) and a psychiatric evaluation prior to qualifying for Aetna’s Gastric Sleeve Coverage in California. If Your BMI is below 40, Aetna will also consider all medical issues and problems related to your weight prior to authorizing coverage of your Gastric Sleeve Surgery.
Aetna Gastric Sleeve Requirements
You may automatically pre-qualify for Aetna to cover your Gastric Sleeve Surgery in California if:
- You are 100 pounds or more above ideal weight, or
- You have a Body Mass Index of 40 or greater, or
- You have a Body mass Index of 35 or greater and suffer from medical problems associated with obesity such as type 2 diabetes, sleep apnea or hypertension.
- You have been overweight for at least two years, and
- You have been unsuccessful at all weight-loss attempts including diets, exercise and weight loss programs.
Aetna provides medical benefits in all 50 states to approximately 37.9 million people, comprised of employer groups, individuals, part-time and hourly workers, health plans, governmental units, government-sponsored plans, college students, labor groups and expatriates. Aetna’s national care network is comprised of more than 1.2 million health care professionals, 690,000 primary care doctors and specialists and more than 5,700 hospitals, offering services in California through Aetna Health of California, Inc.
Other insurance carriers
- Does Blue Cross/Blue Shield cover gastric sleeve?
- Does United Healthcare cover gastric sleeve?
- Does Cigna cover gastric sleeve?
- Does Humana cover gastric sleeve?
Disclaimer: This site is not affiliated with or endorsed by Aetna and is for informational purposes only - The following Aetna Gastric Sleeve guidelines have been compiled from various public sources. It is presented online for informational use only, and without warranty as to its accuracy, timeliness, or completeness. This site does not replace any official versions of the information presented, nor does inclusion on this list guarantee coverage. Please check your Aetna policy before proceeding with your surgery.