Will most health insurances require that an aortic aneurysm > 4.5 cm before paying for surgery?

Question

I am 37 year-old male who has been recently been diagnosed with an aortic aneurysm in the area of 4cm. I will not know the exact size until 08/20. I am not going to be available for surgery for two years if I do not immediately go under the knife. Will most insurance companies pay for the surgery if the diameter is less than 4.5 cm? I currently have Humana and wonder about their coverage?

Answer 1

call them.  don't expect most people on here to know.

Answer 2

If the surgery medically necessary, Humana will pay for it. Huge generalization of course - not knowing all the details.  But you are going to have to stay with Humana, no other insurance company is going to issue you a policy with a pre-existing condition like that.

Don

http://mtnhealthinsurance.com  

Answer 3

Insurance issues aside, most vascular surgeons wait until the aneurysm is 5cm or larger before operating. The exception is if the aneurysm started growing rapidly.

Why? Actually, it's simple. Numerous studies have shown that there is no mortality benefit to fixing a 'small' aneurysm. The risk from the surgery for a small AAA is actually higher than the risk from the aneurysm.

If the AAA is around 4cm, then we usually get annual ultrasounds.

Answer 4

follow up with your surgeon and the billing department.

Answer 5

There are a lot of questions I'd like to ask to give a better answer.  Given the information I have:

If 4 cm is near the aortic valve, and you are high risk, the surgeon may recommend it thus the insurance should pay.  If it is away from the root even patients at high risk usually are put off to close to 5 cm in ascending, 6 cm in descending and/or abdominal.  They (and you) shouldn't rush surgery unless there is a major reason to suspect a rupture because life is just easier before surgeries and there can be other complications to surgeries also.

Not sure why you are not available for 2 years, they tend to make their own time frames.  If you are planning to drop insurance other than if you can get a group insurance policy and survive the pre-existing clause... you will be hard pressed to find insurance.  In today's world you really are better off continuing some type of insurance even if more expensive for a while.  You also never know what tomorrow will bring and you may need the insurance for another reason.

I don't have Humana, but in general I think it will depend on the surgeon's recommendation and I don't know any that are going to want to do the surgery when risks outweigh the potential results.

Answer 6

Call your Humana rep and tell him/her exactly what you said here.

He/she should know the answers better than anyone else.

Answer 7

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