Summary Plan Description

Bariatric Surgery

90% Network Only
Services and Supplies Must Be Received From A Network Provider
Services and Supplies Must Be Precertified
The Bariatric Surgery Benefit Is Not Available Under Retiree Coverage

Surgical procedures for morbid obesity including Roux-en-Y gastric bypass (RYGB), FDA-approved adjustable gastric banding, or sleeve gastrectomy are covered at network providers only. All procedures must be precertified and are subject to the criteria set forth in Aetna Clinical Policy Bulletin (CPB) 0157. Aetna will also review the pre-surgical treatment plan to ensure the patient meets the plan's medical criteria. Aetna will provide coordination and facilitation of treatment plan components as necessary. To initiate the precertification process, your physician must contact Aetna.