SHBP Update
Yesterday I called the State Health Benefit office (actually I called someone else and they transferred me to the SHB office). The number is 404-651-6141. I spoke with a lady and basically asked her what the policy was going to be.. This was after I had called UHC and they rep there told me that she did not have any information except that the surgery was going to be covered on the HRA plan.
Ok in talking to the lady at the SHB office, she said that the vendors (UHC and Cigna) should have the necessary information and I should call them back.. basically all she had was general info. which was I would have to go through all the basic stuff.. Center of Excellence, medical necessity, nutrition classes (she said 6month diet too).. this lady was actually very helpful and was very nice.. she was understanding... you know how some people are when you tell them you want to have wls they start asking you why and all that jazz... anyway, she was very helpful and nice..
Well I called UHC back and the rep there seemed more informed than the one I talked to just an hour or so beforehand.. she basically told me the HRA and HDHP would cover it.. but I would have to have a Pre-Determination sent in for review by the Care Coordinator for it to be approved. She did not mention a 6 month diet or any other qualifications. All she would tell me was that they look at it on a case by case basis...
ok so here are my questions...
Which ins. company is easier to deal with Cigna or UHC?
I know it seems like I'm rambling in this post but this crap is soooooo confusing..
Also, I've read these boards for a long time but I never signed up until now.. I have learned a lot here and it is very comforting to know other people out there are dealing with the same things i am on a day to day basis..
I will post more as I learn more..
I was going to post an update of sorts, so I will dovetail onto your post.
It seems like the right hand has no idea what the left hand is doing and visa versa.
In speaking with UHC, they stand by the fact that the UHC HRA and the HDHP (High Deductible) plans will over WLS.
In speaking with Cigna, they stand by the fact that ALL Cigna plans will cover WLS...HMO, PPO, HRA, & HDHP.
Speaking with the SHBP, they said (like you mentioned) that they know WLS will be covered and it is definitely covered under the HRA and HDHP plans. Other than that, they know nothing. I'm trying to get someone to provide me with the "Plan Summaries" but SHBP said they won't be up until after the first of the year! Lot of good that does me when I'm trying to compare apples to apples.
As for your question to which is easier to deal with? The SHBP hasn't had Cigna as a provider in recent history, so who knows. If you are looking for "in general", that might be a better question to ask in the insurance forum or the main board. Or maybe call the surgeon's office you plan to use and ask them. As far as requirements for WLS, Cigna has them on their website (and they mailed them to me before I found them). Cigna's requirements are: 1. BMI >40 for at least the previous 24 months or BMI >35 for at least 24 months with 1 co-morbidity. 2. Active participation within the last 2 years in 1 physician-supervised weight management program for a min of 6 months (apparently, WW or Jenny Craig are acceptable alternatives in conjunction with physician supervision). 3. Evaluation by a multidisciplinary team within the last 12 months including: eval by bariatric surgeon, PCP eval, psychologist visit/report, and nutritional eval by physician or dietician.
This is just a brief snapshot of Cigna's coverage policy. I tried to find a similar policy on UHC's website and haven't found it yet.
Good luck!
Elli
Highest Weight/Surgery Weight/Current Weight/Goal
426.4/356/216.8/165?
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Dr. Larry L. Hobson 
| If you are a Center of Excellence and do not see your contact information listed, log into your application and update the Public Contact Information section listed under the Contact Information tab. |
http://www.surgicalreview.org/locate.aspx?state=US-GA#srchRe sults
That's where I got this info. I also thought Emory (downtown) was a Center for Excellence, but they aren't on this list...
-Elli
Highest Weight/Surgery Weight/Current Weight/Goal
426.4/356/216.8/165?
