CIGNA-PPO HAVE QUESTIONS????

i'M GOING THRU ALL THE PROCESSING OF HAVING THE SURGERY...BUT I'M FEELING SICK EVERYTIME I RECEIVE A STATEMENT FROM THE INSURANCE ON WHAT THEY HAVE COVERED ...AND IT STATES IT DOESN'T COVER WEIGHT LOSS...SURGERY FOR REDUCTION OF WEIGHT....NOW I ASKED HR AT MY JOB FOR COPY OF POLICY AND THE EXCLUSION STATES ONLY MEDICALLY NECESSARY..NOW I CALLED CIGNA AND YOU CAN FORGET THEY GIVE SOME BULL---- STORY HOW THEY ARE ONE OF MANY STATES THAT DISCONTINUED SURGERY...PLEASE ANYONE HAS HAD SURGERY THIS YEAR OR HAS HEARD ANYTHING....I HOPE TO HAVE ALL MY PAPER TURNED IN BY MID NOVEMBER!!!!!!!!!PLEASE HELP!!!!!! maddy

My husband has Cigna HMO and he just got approved for lap RNY. He is scheduled for surgery on November 9th. He was approved in 3 weeks. We've also heard that in some states they won't be covering g.b. in 2005, which made him work extra hard to get everything his surgeon told him Cigna required... 6-months of doctor-supervised diet, gall bladder ultrasound, psych evaluation, thyroid bloodwork and nutrition evaluation. I hope everything goes as smoothly for you as they did for him.

Hi Maddy- I have Cigna PPO as well, and just submitted my paperwork today. As you probably know, all Cigna policies are different. It sounds as if your policy is similar to mine-WLS is only covered if proven medically necessary. Don't believe the Cigna reps on the phone, believe your company's coverage handbook. Regarding the pre-op testing-I had the same issues as you. Things being denied due to the same reason. Call your docs and explain the situation. Ask them to use an alternate diagnosis/and or procedure code and resubmit the charges. (For example, endocrinologist bloodwork that reflects other health issues.) Doing this has saved me tons of money! I still had to pay for an Upper GI (as my surgeon had requested it) and my consult( can't get around that fact), but upon approval (God willing) I will be asking for reimbursement, after the surgery has been deemed medically necessary. I hope this helps! Good luck, Aly