SHBP New Update

Sorry, but sadly, this appears to be accurate.  They are saying you need 6 months with PCP for supervised diet and 6 months of behavioral therapy and it can't start until January '09.  Doesn't make sense to me. 

Personally, I've already started the PCP visits and plan to contact a therapist to get it started.  I'll apply when I'm finished with the 6 months in March or so.  Worst that could happen is they say no, and I reapply for pre-auth in June.

This appears to be under UHC, I haven't heard about the therapy component from Cigna or waiting until January '09 for visits.

-Elli

I talked to Cigna today and printed their coverage information off their site. You are NOT limited to the Centers of Excellence. You can choose anyone in their network.

Here is a link to the site:
http://snipurl.com/4ji34

This is a 30+ page document that lists everything about Cigna and Bariatric surgery.

I spoke with United Healthcare and Cigna today. The United Healthcare representative confirmed that 6 months of behavioral counseling would be required in addition to the 6-months of supervised weight management. Cigna didn't list the behavioral counseling as a requirement, but only allows you to choose from 3 Atlanta hospitals as another poster mentioned. I am really diappointed because I don't want to change surgeons. I also don't want to delay the process until July as I am almost through with my monthly visits with my PCP, have seen the psychologist and the nutritionist.

If you read the document above which I got from Cigna's website, you will read that you are not required to use those hospitals.

I know exactly what you are talking about.  I questioned that too.  After investigation, the customer service rep I talked to said that while in general, Cigna members are not restricted...SHBP is REQUIRING that only those 3 hospitals are used by their members.

Crazy I know.  Call and speak to difference customer service reps and get different answers.  It's HORRIBLE!

-Elli

The Cigna representative I spoke with actually read the three hospitals to me.  I specifically questioned the hospital I was interested in (which is a Center of Excellence) and she said it was not approved.  I was referred to this link http://www.cigna.com/js/partner/bni/bariatric.pdf.   I did see that the doctor I hoped to use will be on Cigna beginning 1/1/09, so I'm hoping that he may work out of Northside in addition to Emory Johns Creek as it appears his partner does.  I have a call in to Atlanta Bariatrics to find out.

You and I are using the same surgeon.  Please post when you get the answer.

I questioned that too...because as of January 1st, Dr. Johnson will be a "Cigna Certified" something-or-other.

Thanks!

Elli

I just spoke with Susie at Atlanta Bariatrics and she said the neither Dr. Johnson nor Dr. Hart will perform bariatric surgery at Northside.  They feel more comfortable with their patients being right down the street at Emory Johns Creek.

Now I'll have to weigh whether waiting 9 months or more is worth it to keep the same doctor.  I really felt comfortable with Dr. Johnson.  He performed my sister's bypass in April and she was very pleased.  I just don't know if I can handle being "on the fence" for 9 more months.

Hi guys... I'm waiting to get all paperwork in by nov 10th and then get approved for surgery in dec... my ins is changing to UHC and I"m sooo terrified about getting put off.

I beleive the behavioral stuff is a diet supervised by a dietician.. i'm going to my PCP, the dietician rachael at the office,exercise physilogist (sp)... I am sooo dr'd and behavioraly overloaded... it's all a bunch of crap.

Too bad about dr. J and H not doing surgery at northside... It's a really great hospital but then again it's good that they are close by.....

Lauren

That's very exciting.  November 10th is around the corner (even though it doesn't feel that way right now). 

Most people have reasonable luck with UHC, it's the SHBP that's put other restrictions.

You think the behavioral stuff is the dietician?  I thought I would have to see a psychologist.  I'd rather see the dietician (I'd get more use out of that!)  Hmm...I'll have to call UHC back and see what they say.  And I keep meaning to ask you about the exercise physiologist.  What's that all about?  Is that something new Dr. Johnson's office started?  That wasn't a requirement for me when I originally "signed on" with them.

As far as Dr. J & H not doing surgery at Northside, it just means picking UHC instead of Cigna.  Though UHC seems to have more restrictions...like not being able to start PCP & behavioral therapy visits until January '09.

My fingers are crossed for your stuff to all go through swiftly!
Elli