Does Aetna Cover Weight Loss Surgery?

Does Aetna cover weight loss surgery? While most forms of weight reduction surgery are covered by Aetna, there may be some changes from policy to insurance, so be sure to check yours for specifics. Most Aetna HMO policies and Aetna QPOS plans limit coverage for obesity-related surgical treatments unless Aetna improves the surgery personally. Determine whether or if your particular Aetna coverage covers weight reduction surgery by contacting the insurance company directly.

Coverage standards for adults and adolescents are in place with Aetna insurance. At least 24 months of being classified as severely obese is required for adults over the age of 18 to meet the definition of severely obese. Severe obesity, as described by Aetna, is when:

  • Above specifically, a Body Mass Index (BMI) of 40 or more.
  • A BMI of 35 or higher when combined with a significant amount of comorbidities.
  • Obstructive sleep apnea, coronary heart disease, medically resistant hypertension, and type 2 diabetes are all examples of co-morbidities

How Does Does Aetna Cover Weight Loss Surgery?

Adolescents should be:

  • If you’re a girl, you must be at least 13 years old, or a man, you must be at least 15 years old
  • A BMI of 40 or more, in addition to one of the major comorbidities listed above, or pseudotumor comorbidity, or both

Patients, whether adults or adolescents, must have a history of unsuccessful attempts to lose weight in the past. In order to establish their readiness for surgery, the patient will have to go through either physician-supervised nutrition and exercise program or a multidisciplinary surgical preparation plan. In order to evaluate if surgery is the best option for the patient, this must be documented by the patient’s doctors. As a result, Aetna has extremely precise documentation criteria that must be met if you want your weight reduction surgery to be reimbursed. In order to get a clear picture of what this means, you’ll need to talk with your insurance provider.

You may be required to choose an in-network physician for your weight reduction surgery under some Aetna plans, but this is not always the case. It is almost always cheaper to go with an in-network doctor or hospital. Aetna can help you figure out where to go for weight reduction surgery so that you can get the greatest outcomes for the best price, according to your specific insurance coverage.

How To Have Supervision For Weight Loss Surgery?

In the patient’s medical records, the doctor has noted the patient’s involvement in the food and exercise regimen. Before surgery, the patient may be prescribed an exercise and diet plan, and the surgeon may oversee the patient’s compliance with the plan. A physician’s letter summarizing their findings does not meet the criteria for acceptable documentation. Include the following information in your documents:

In the doctor’s medical records, he or she notes the patient’s progress in exercising and eating well. Physician-administered fitness and nutrition programs can provide an alternative to medical records for patients who are participating and progressing. In the exercise and diet regimen, a doctor will collaborate with nutritionists and dieticians.

Before surgery, a program must utilize for six months or more. Including a three-month subscription in one of these programs. After six months of involvement in the diet and exercise program, you may allow to certify even if you haven’t finished the program.

When To Get Aetna Cover Weight Loss Surgery?

To ensure a positive surgical outcome, minimize complications, and establish the patient’s ability to deal with and adhere to post-operative dietary restrictions and medical care, patients must begin an intensive three-month multidisciplinary pre-operative regimen no later than six months before the scheduled surgery date. A doctor supervises a behavioral change program. Consultation with a dietician recommended. Recording the patient’s participation in their medical records at each visit. A doctor’s summary letter is not sufficient documentation. Rather, the paperwork should include:

Initial and follow-up assessments by the doctor documented in the medical records. Before surgery, patients should participate in an exercise program designed to increase their pulmonary reserve under the guidance of a trained expert or exercise therapist. The program must have conducted in person, rather than through the internet. A calorie-reduced nutritionist-supervised diet plan.

Types Of Weight Loss Surgery That Aetna Cover

In order for persons with mental disorders, such as borderline personality disorder (BPD), schizophrenia, or severe depression to undergo a procedure, they must first have pre-operation psychological permission from a psychiatrist/psychologist or psychotropic medication user.

Obesity-induced sadness isn’t to blame for people’s reluctance to get surgery. Surgery for weight loss cover by Aetna for four different types of procedures:

  • Gastric Sleeve
  • Duodenal Switch
  • Gastric Bands
  • Gastric Bypass

Duodenal Switch

The biliopancreatic diversion with duodenal switch (BPD/DS) treatment may recommend by your doctor. The duodenal switch commonly refer to as this. It is more effective than either the gastric bypass or the sleeve gastrectomy in terms of weight loss, according to experts. Studies have shown that the procedure aids in the reduction of obesity-related diseases. Heart disease, hypertension, and especially type 2 diabetes are all examples of these conditions.

As a result of BPD/DS, your ability to absorb calories, vitamins, and minerals reduce to the point where you can lose weight. The duodenal switch is more effective than either the gastric bypass or the sleeve gastrectomy in terms of weight loss. Afterward, you’ll be more susceptible to nutritional shortages. Some of these conditions, if left untreated, are potentially fatal. These and other surgical hazards should carefully weigh against the advantages when deciding whether or not to have surgery.

Weight reduction handled in three distinct ways with BPD/DS. A sleeve gastrectomy is the first step in the treatment process. The stomach partially remove with stapling equipment. So, it is leaving a thin tube running the length of the stomach from the top to the bottom. You will eat less food and consume fewer calories if you have a smaller stomach.

Redirecting food away from the top portion of the small intestine, where digestion takes place, is the second step of this operation. As a result, your body is unable to absorb as many calories and nutrients. A link create near the end of the small intestine after the gut separate.

Does Aetna Cover Gastric Sleeve Surgery in All Their Plans?


So are you wondering, “does Aetna cover gastric sleeve?“ Aetna covers weight loss surgery sleeve, depending on your chosen plan and your doctor’s recommendation. However, you should check with your plan administrator to confirm that your specific plan includes coverage for gastric sleeve surgery. In general, they will cover surgeries that are deemed medically necessary and could help improve the health of their member. Therefore, you should review any coverage rules or limitations contained in your policy before receiving care. It is also important to note that Aetna requires pre-authorization for most bariatric surgeries, including gastric sleeve surgery. Therefore, it is critical to speak with your doctor and insurance provider to ensure that all necessary steps are taken before the procedure.


It is recommended that you visit Aetna’s website or contact their customer service department if you have any questions about the specific coverage included in your policy or if you need help understanding how to file a claim for the cost of gastric sleeve surgery. Doing research ahead of time and speaking directly to Aetna will give you a clearer picture of what to expect from your coverage, and answer “does Aetna cover gastric sleeve?“