Does Aetna cover surgery?
Asked by: Arlo Johns Jr. | Last update: October 3, 2025Score: 4.2/5 (59 votes)
Does Aetna cover anesthesia?
Aetna also covers general anesthesia or IV sedation in conjunction with dental or OMS services that are excluded under the medical plan when the criteria below are met.
Why did Aetna deny my surgery?
There are many reasons why a precert could be denied such as not enough documentation submitted by your surgeons office, didn't get clearance from the required specialties yet, not 12 visits completed or your plan specifically does not allow bariatric services/or only at certain facilities but your isn't one of them.
Can surgery be covered by insurance?
Generally, yes. But some states require insurers to cover additional services and procedures. Even within the same state, there can be small differences.
How long does it take Aetna to approve surgery?
Once your doctor sends a request for prior authorization, Aetna reviews the request. During our review, we look at the most recent and highest quality medical research and guidelines. We update your care provider throughout the review process to keep them informed on the status, and come to a decision within 14 days.
AETNA Breast Reduction Surgery Guidelines for Coverage #plasticsurgeon
Does Aetna cover elective surgery?
Elective or cosmetic plastic surgery procedures are typically not covered by Aetna insurance policies.
Does Aetna deny a lot of claims?
In the same year, Medicare denied 6.85% of its claims. One year later, AMA reported that all the surveyed insurers were denying fewer claims: Aetna's denial rate was down to 1.81%, Anthem BCBS reduced its rate to 4.34%, and private insurers overall were down to 2.79%, while Medicare denied only 4% of claims.
How do I know if my insurance covers surgery?
If you have any questions about what your plan covers, contact your insurance company. Member Services representatives are there to answer exactly these types of questions. They can tell you whether a doctor, prescription or service is covered, plus how much your insurance will pay.
How much can surgery cost?
The average hospital stay is 4.6 days, at an average cost of $13,262. If surgery is involved, hospital costs soar through the roof. Some of the most common surgeries have price tags that top $100,000. Those are alarming figures, especially for families with limited budgets or no insurance.
Do I have to pay my deductible before I can have surgery?
In other situations, including a pre-scheduled surgery, the hospital or other providers can ask for at least some payment upfront. But in most cases, a health plan's network contract with the hospital or other medical provider will allow them to request upfront payment of deductibles, but not to require it.
Why is my insurance not covering my surgery?
Reasons your insurance may not approve a request or deny payment: Services are deemed not medically necessary. Services are no longer appropriate in a specific health care setting or level of care. You are not eligible for the benefit requested under your health plan.
Which health insurance denies the most claims?
According to the analysis, AvMed and UnitedHealthcare tied for the highest denial rate, with both companies denying about a third of in-network claims for plans sold on the Marketplace in 2023, respectively.
Can you be denied surgery if you cant pay?
If medical debt goes unpaid for a period of time, a hospital or other health care provider may decide to stop providing you services. In some areas, you may have few other options for medical care, but in other locations you should be able to find other health care providers to take care of your family.
Is Aetna Medicare or medical?
Aetna is a private health care company that administers your Aetna UN PPO Plan. The Aetna UN PPO Plan covers the same services as Medicare (and more) and coordinates its coverage with Medicare for those who are eligible. There are lots of things to think about when you need medical care — What kind of doctor do I need?
Does Aetna cover implants?
One major factor that can determine if your dental implants are covered by an Aetna Medicare Advantage plan is whether the implants are considered cosmetic or medically necessary. If cosmetic, some plans might not cover the implants. But if the dental implants are considered medically necessary, they may be covered.
What happens if you can't afford surgery?
Hospital charity care may be available based on your income and savings. In fact, according to Fox, some hospitals are required by state law to provide free or reduced services to low-income patients. As soon as your bills arrive, let your providers know if medical problems have affected your income and ability to pay.
How much does a 3 day stay in the hospital cost?
It's easy to underestimate how much medical care can cost: Fixing a broken leg can cost up to $7,500. The average cost of a 3-day hospital stay is around $30,000.
Which surgery is most expensive?
- Bowel-to-bowel fusion.
- Craniotomy.
- Tracheostomy.
- Spinal Fusion.
- Exploratory chest surgery.
- Aortic valve replacement.
- Small bowel transplant.
- Intestine transplant.
What surgeries are not covered by insurance?
Cosmetic procedures such as plastic surgery or vein removal are nearly always considered elective and so are not covered. Fertility treatments are only covered in certain states, and even then, there are loopholes that allow insurers to deny coverage.
How do I get my insurance to approve surgery?
- Your insurance company will review your doctor's request. ...
- Once they've decided, they'll send their decision to both you and your medical provider in writing.
- If your doctor feels that you can't wait that long, they can submit an urgent or expediated request.
How fast can insurance approve surgery?
Depending on your provider, insurance companies can take anywhere between 1-30 days to approve the request. Stay in communication with your care team, as timing for approval varies between insurance providers.
How long does it take Aetna to pay a claim?
If we approve your request, it can take up to 30 days to send payment once we have all the required information.
How to find Aetna copay?
Looking for your premium, deductible, copay/coinsurance and OOP max information? You can find them in your employer's summary plan document.
What is the class action lawsuit against Aetna?
The lawsuit seeks a declaratory judgment, injunctive relief to end Aetna's exclusionary policy, and compensatory damages for all policyholders who have had to pay out of pocket for gender-affirming facial surgery because of Aetna's discriminatory exclusion.