Weight Reduction Programs and Devices

Aetna covers up to a combined 26 individual or group weight-reduction counseling visits per 12 months for adults with BMI ≥30 (pediatric visit count is at the physician’s discretion), considers Plenity medically necessary for adults with BMI 25–40 when used with diet and exercise, and requires specified monitoring for very-low-calorie diets (<799 kcal/day)—EKG after 50 lb loss, lipid profiles at start and end, and weekly then biweekly serum chemistries/LFTs—for up to 16 weeks. Many Aetna plans nonetheless specifically exclude obesity treatments (including weight-loss medications, physician supervision for weight loss, prepackaged foods/grocery items), hospital confinement for weight reduction is not covered, VLCDs beyond 16 weeks require medical review, and diagnostic tests tied to non-covered programs are denied—check the member’s benefit plan for details.

"For Plenity specifically, covered ICD-10 diagnoses (when selection criteria are met): E66."