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

GREAT NEWS!!! 

Oh My Gosh.... I am so happy, I am about to call each representative to find out more information.  I was about to fax my paperwork over to a doctor in Mexico..... I just hope we don't have to jump through hoops to have the procedure.

If you go on Cigna's website, it is possible to find their requirements for surgery.  They do seem to require a 6 month diet, but (and I don't recall specific details) it can be off-set by WW or Jenny Craig or similar plan.  I've been going to WW consistantly since early February, so I should be good.  Just in case, I made an appt to see my PCP this Wednesday so we can start the monthly visits...just in case.  I mean, if I start them now, 6 months will be here by March. 

What I don't understand (and Secail, this is NOT directed at you) is that if this surgery is "meant to be" for someone, isn't it worth waiting for?  Isn't it worth fighting for?  ...even if it means jumping through a few hoops?  I've been working on this since February.  Back in February, I had to see a nephrologist and he mentioned my weight.  Great opening for the WLS discussion.  He was all for it.  Okay, so then I had to clear it with my PCP and my rheumatologist.  Did that by early April (rheumie appt wasn't until April).  Once everyone gave the go-ahead...I went to a rah-rah seminar.  Now, if my mom had her choice, I would have had the surgery over the summer.  She was willing to spend her last dollar to pay for it.  I told her I needed to fight before I'd take the money.  So, I've been fighting.  I hounded every one of my docs to write letters of medical necessity (my PCP was the worst).  I did all the pre-op testing required of the doc's office, met with the nutritionist, etc.  *I* submitted my pre-authorization to the insurance company and waited for the denial.  Then, I hired an attorney.  I'm in the process of that now and discovered it will be covered after the first of the year.  If I had taken my mom's money and done the surgery over the summer, I would be devistated now to know that I literally took all the money she had...and now the insurance is covering.

I'll repeat...anything worth having is worth waiting and worth fighting for.  (Getting off my soapbox now...sorry, I've wanted to say that for a while)

Have a great evening!  BTW, I'm still awestruck about SHBP covering WLS.
Elli

Does this include teachers?  Ohhhh... the money I just spent.  Oh well.... I still wouldn't regret spending it. I couldn't take one more minute living as I was.

This is WONDERFUL news!  Congrats to all of those who will benefit from it. 

It includes anyone covered by the State Health Benefit Plan, which does include public school teachers (I'm an SLP in the Cobb Couty School System).

And yes, it is wonderful news.  The SHBP used to cover WLS but put it as an exclusion maybe 5 or so years ago.  A co-worker's husband had it...must have been right before the exclusion.

-Elli

Hi. I'm new to these boards. I just got my open enrollment information and searched and found you guys. I am SO excited I'm about to cry!!! There was no way I could ever afford this without insurance, so this is a godsend. I just wanted to share with someone about how excited I am!!

Ok I just left the Health Benefits fair in my county (Floyd), and here is the info. I got.  I was previously told that all of Cigna's plans are going to cover the wls but that does not seem to be the case.  I swear I talked to a representative from Cigna for 1/2 an hour two deays ago and he told me ALL their plans coverered it..

So everyone call and ask questions for yourselves.. and they also advised me to ask for a representative who dealt with just SHBPs, when calling.

I'm going to choose the HRA but I'm not sure which ins. company yet... which is the best bet as far as wls surgery goes.. Cigna or UHC? 

Very interesting.  I have spoken to 2 different reps from Cigna.  1 a couple of weeks ago when I first posted this information and 1 yesterday.  Both swore that all Cigna plans would cover the surgery.  I want to see the "Plan documents" but they are not online yet (though everyone says they should be up already). 

Also, when you call Cigna, if you call the regular Cigna number (that I originally posted) they will transfer you to a SBHP rep.  If you call the Cigna number that is in the Decision making guide, you go straight to the SBHP rep.  No need to officially ask for one.

All of Cigna's plans are supposed to cover it and under UHC only the HRA and HDHP will cover.  I'm not making a firm decision until I see "PLAN DOCUMENTS"...even if it means I have to go to the Department of Community Health and rip them out of Dr. Rhonda Medows hands!

Do you know the answer to this question?  If one chooses one of the HDHP plans, do you use the PPO docs?  I mean you can use "any" doc, but get better rates at an "in-network" doc...so is it the PPO docs that are considered in-network for the HDHP plans?

-Elli

To my understanding (I'm not expert so don't bank on my knowlege), the PPO docs are the ones you choose from with the HDHP as well as the HRA.

OK so I just called UHC and the rep there said she didn't have ANY information except that the surgery was going to be covered.  She said she didn't know at what percentage or anything.  I asked her wouldn't it be covered at the same rate as other outpatient or inpatient surgery.. she said no it would depend on the employer.  She said the people at the SHBP didn't have this info. either. 

This is really frustrating..