Question:
Anyone have Cigna PPO and approved for LAP?

Hi...I have been told that my insurance company does not cover for lap - the reason they use is they say that it is still in the experimental stages. I have been told by my surgeon and others that it is no longer in the experimental stages, but they say it is. Has anyone with Cigna PPO been approved for lap instead of open? I'd rather have lap, but if it has to be open, then that's what it will have to be. Besides, I know that even with lap, there is the slight chance the surgeon may have to convert to open. Are there two different codes when they are submitting the pre-approval to the insurance company (a code for open and then a different code for lap?). Any help is greatly appreciated. Thanks!    — Giovanna G. (posted on May 2, 2002)

May 2, 2002
I have CIGNA PPO and I had open only because that's the only procedure my doctor did. I think it would be up to the physician. If all he does is lap, then I believe the insurance should cover it. Did you get the information from your insurance carrier? If so, I'm surprised because when I was calling for pre-approval, they asked me if it was open or lap, so I don't know why they wouldn't approve it.
   — dolphins94

May 2, 2002
5/02/02 I have Cigna PPO and had no problem what so ever with approval for Lap, as a matter of fact once it went to Medical review at Cigna I had approval in 1 hour. I am not sure why you are being told you can only have open, Please email me at [email protected] if I can answer any other questions Good Luck
   — Jeri P.

May 2, 2002
CIGNA PPO approved lap RNY surgery for my husband and I with no questions asked. We received approval within 3 weeks of our surgeon's letter of medical necessity. Good luck!
   — Diana T.

May 2, 2002
Giovanna, When you talked to Cigna and they tell you that they don't cover Lap. Tell them that's not what your paperwork says. Be persistance with the person you are talking too. Make them think you know something that they don't. Oh yea be nice while doing all this. I did this because they told me that they didn't approve Gastric by-pass at all. I was approved in about 4wks. My Cigna insurance is HMO. The difference being my PCP had to refer me to the surgeon, otherwise I would not have ever gotten in to see him without it.
   — J S.

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