STATE OF GA EMPLOYEES - GREAT NEWS!!!!!

As you probably already know, open enrollment starts October 10th.  I have just gotten off the phone with Cigna & UHC.  As of January 1, 2009,

SHBP WILL COVER WLS!!!!!!!!!!!!!!!!! 

According to the nice lady at Cigna, all their plans will cover the surgery.  According to the lady at UHC, only the HRA and HDHP will cover WLS. 

**Disclaimer** Don't make any decisions based on my post...do your own research before changing plans please!
-Elli

 

Great NEWS>>> so what plan are you on?

So UHC has a HRA plan and HDHP plan and those 2 will cover it???

We are so off sync... my plan is changing for the worst ( i think) and yours just kicked some but... Yeah...!!

Curiouscat

Currently I'm on the United Healthcare HMO, which as far as what I was told today WILL NOT cover the surgery.  Being that it is "open enrollment", I can change to any darn plan I want!  The lady at Cigna said ALL their plans will cover the surgery, if it is deemed "medically necessary".  I don't have my paperwork in front of me, but if memory serves me correct they have a Cigna HMO, Cigna PPO, Cigna HDHP, and a Cigna HRA.  UHC offers HMO, PPO, HDHP, and HRA...but according to the UHC representative, only the HDHP and the HRA will cover the surgery.

I will either go for the UHC HDHP or (more likely) the Cigna PPO.  I am soooooo excited!  This takes such a load off.  And now I don't have to worry about draining my mom's savings to have this surgery (I'd have been skinny, but damn poor!)  I have been given a gift.  This surgery is meant to happen for me and at this time.  Just think if I had gone thru this a year ago.  I would have paid out of pocket and now, been very depressed!

-Elli

Hi Elli,

I just called my contact with the state benefit plan in Atlanta, I left a message to confirm this.  IF they do cover the surgery in 2009.  Your best bet will be UHC.   Cigna will require a 6 month supervised diet.  I will let you know what she tells me.  When you called Cigna and UHC, what information did you give them to confirm they will cover it?  Do you have any numbers to share, I'll be happy to call too. Let me know and I'll let you know what my contact tells me.

Here's how my morning played out...I was looking at the Decision Making guide for insurance choices 2009 on line.  This is really not the greatest book...but it allows you to compare general things about each plan offered side-by-side.  There was a passage in a section that specifically stated "HRA & HDHP Enhancements".  The passage read that they would cover treatment for morbid obesity if treatment is sought at a Center of Excellence.  So, I emailed the benefit manager for my school system to see if she had any information.  She didn't know a thing and gave me the phone number for SHBP.

Called SHBP.  They couldn't answer the questions either, but gave me the 800 # for Cigna and UHC.

I called Cigna and told them I heard a rumor about WLS being covered in the new year.  The representative confirmed this.  She said the information was just added into the computer yesterday and that WLS would be a benefit under all the plans Cigna was offering to SHBP participants as long as it was deemed "medically necessary".  I asked her to confirm again.  She did.  I asked what the requirements would be...she's mailing me a packet with information.

Then, I called UHC and had the same conversation with them.  They said it would only be covered under the HRA and the HDHP plans, not the other plans.  She wasn't as nice as the Cigna lady...and my conversation not as long.

For anyone reading this who may not know the acronyms...

SHBP = State Health Benefit Plan;  HRA - some sort of health savings acct;  HDHP = high deductible plan

The phone numbers for Cigna and UHC are in my car...I will bring them in and post this weekend.  And I really just told them I was a participant in the SHBP and they were providing insurance for us and open enrollment is coming in a couple of weeks.  Cigna actually transferred me to a customer service rep who specifically handles SHBP.

As far as what I will choose?  Well, with my medical issues, I am more comfortable with an HMO or PPO, so chances are I will go with Cigna.  According to their online documents, yes, they require a 6 month diet...and it appears they will accept Weigh****chers.  I've been going to WW since 2001...but in recent time, I've been going consistantly since February.  And just in case, I scheduled an appt with my PCP for next Wednesday.  If I start visits now and they really want the 6 months, I'll be finished in March. 

I feel as though I've been given a gift.  I'm very grateful!

After reading over the information it looks like the HRA is probably the best bet.  My husband is a state employee and we had BCBS, so we have to change this year.  We are probably going with UHC and the HRA.  That looks like the best one even in terms of getting the surgery.  The HMO and PPO doesn't cover weight loss, it has to be a HD or HRA plan according to the site.

 Wow! This is crazy! Do you know if they will cover the VSG? Any idea what UHC's requirements are?

You mentioned where it said they would cover WLS -- do you have that link? 

I am scheduled to have surgery on 10/08 -- so I am torn between wanting to go ahead and do it -- and wanting to save a bundle of money!!! lol

Thanks!

Kimberly

It will not cover VSG (at least not Cigna) because they still consider it experimental.  I was planning to have the VSG too but only because my nephrologist was uncomfortable with the RNY due to other issues.  He and I are going to "duke it out"...if insurance will pay for RNY, I'm having RNY.

As far as info regarding open enrollment, go to www.dch.georgia.gov . On the left side of the screen, click "State Health Benefits Plan".  Scroll down to "active employees" and click on "decision guide".  Look at page 4 of the decision guide.

I scheduled my surgery for December 15th, figuring I could postpone if my appeal hadn't been finished yet.  Now, I will wait until January (maybe they can submit stuff in December...)

-Elli

Hi... Elli

I'll take that date.. I need to get it in before Jan.

My inusrance is changing....

Curiouscat

Thanks for posting this information.