Insurance question??

In my Cigna PPO it says that bariatric surgery is not covered.

I was told by a coworker today that it will be covered if a doctor says that I need it.

Is this true?

Thanks!

I would call Cigna PPO tomorrow and ask them if it is covered under any cir****tances. Sometimes, if there are comorbalities, e.g. diabetes, high blood pressure, sleep apnea, asthma, they may cover it.

Barb

Will do!

Thanks!

This is the story with your insurance. It may be a covered benefit under your Cigna PPO but, if it is not a benefit that your employer purchased then you co not have coverage.  I suggest that you contact Cigna and see what they have to tell you.
Liz

I looked through the informations sheets on my PPO as well as the HMO plans. And it says that the HMO will cover WLS but PPO will not (even if recommended by a doctor).

Should I talk to Cigna now, or should I wait until after I can change to the HMO plan in january 1st 2010.

I'm just afraid that they will deny my change to HMO, if they already know that I'm doing it in order to get the WLS.

Or are my fears unfounded?

Thanks!

They can't force you to not change to HMO. You know though you will have issues with the HMO. I would get myself into weigh****cher this year to show that you have done a 6 mo montiored weightloss program.  THis is a really controversial issue here.  BUt if you don't really have the benefit you may as well do what will be required by the med grp to avoid all the bs of having to appeal and all that junk.  Again, call Cigna in the morning and talk to member services.  But, I will tell you from experience if you do not have a benefit there is nothing you can do to make them cover.
Liz

Hi Liz!

What are the issues with HMO?

The 6 month weightloss program is a good idea. But another member here told me that we are excempt from the 6 month program here in california. Did you have to do the 6 month program?

But you are right, I will call them tomorrow to find out exactly how it works.

Thanks!

Casper.

The 6 month thing is what is controversial here.  I personally believe that you need to take that time to educate yourself.  You can take it to the department of managed care.  But, it your situation is the case and you do not have ppo coverage you will need to change to the hmo for coverage.   I will still check it all out.  When you speak to someone at the insurance co get their name. If they sound a bit confused about this ask to speak to the supervisor or lead person,
GOod Luck
Liz

Hi!

Do you know if I can already do all my 6 month preparations now, or do I have to be on the HMO plan in order for it to count?

Thanks!

Casper, you will need to know the details of what the HMO requires to answer this question. Some require a "medically supervised" diet where you have to see a doctor every month are get this documented. Some have you see a dietician. Some accept things like Weigh****chers. It's all on the details.
    So check the HMO's policy, but keep in mind they could also change their requirements by the time you get there next January.

Larra