Cigna - SHBP

Here is a link to Cigna's policy for the SHBP.

http://snipurl.com/4ji34

Also, you DO NOT have to wait until January to start the doctor supervised process. (UHC requires that you wait until January.)

You must use the Centers of Exvellence, no matter which insurance you choose!

That link is just Cigna's policy in general.  It doesn't include anything that has been added specifically for SHBP. 

And how did you get the info about UHC not letting one start the process till January?  Last week, they said nothing of the sort when I asked.

I'm still very frustrated with this whole process.

-Elli

The UHC representative I spoke with yesterday said that Optimum Health Bariatric Resource Services would be handling the process (how much I'm not sure).  It sounded like you couldn't begin the 6 months of presurgical outpatient counseling until January. 

This is very frustrating.  It's a big decision to make without all of the facts.

I don't know about the company - she didn't mention that. But, she was very clear that you can't start the process until January.

I just got off the phone with UHC.  And you are right, you can't begin the PCP visits until January.  No mention of outpatient counseling though.  I specifically asked about it.

This is a bunch of hogwash!

-Elli

The Cigna lady said that that is what SHBP is following.  I got the UHC info from Sherika at UHC. I specifically asked that question.

My doctors office told me that Cigna is really tricky to work with and to make sure EVERYTHING they ask for is specifically documented each and every time you see the doctor with the 6 month diet or they will deny and you have to start from scratch.

I am frustrated, too. I think we are gonna go with Cigna, since I am over 2 hours from Atlanta. I want to stay with my Athens doc and hospital.

Spoke with the folks at Cigna today and the hospitals they require are all in ATL... Emory, Northside, and one more.. i don't have the info... right here but i will post it tomorrow when i get back to work.

You are right...it's Emory Crawford Long (have to put in the Crawford Long part because it's only that branch of Emory that's approved by Cigna), Northside, and Atlanta Medical Center.

For UHC, the only 2 hospitals are Atlanta Medical Center and Emory Johns Creek.

-Elli

I just spoke with Cigna and UHC yesterday. Both stated you have to choose either the HRA or High Deductible plans to cover wls. Both stated the HMO and PPO wil not cover wls. This is all very confusing. I think I will choose the HRA just to play it safe. The only problem now is deciding betwen Cigna and UHC.

LaShelle,
It's not possible to PM you, so I'll just have to summarize it all here for you.  This is what we've figured out after weeks of calling SHBP, UHC, and Cigna non-stop (literally, I've called at least 1 of them everyday).

Yes, you need to take either the HRA or the HDHP plan for either UHC or Cigna.  The HMO and PPO plans will continue to exclude the weight loss surgery, period!

If you choose UHC, you can only use Atlanta Medical Center or Emory Johns Creek for your surgery.  Also, if you choose UHC, you can't start jumping thru the hoops until January '09.  And by "jumping thru the hoops", I'm referring to 6 months of PCP visits, 6 months of behavioral counseling visits (I suspect this is meeting with a nutritionist, but UHC couldn't tell me for sure), etc.  And if you choose UHC, you need to call them before you start the process of all your visits.  With them, you will be monitored by a separate company called Optimum Health Bariatric Services (not part of UHC) that will help guide you thru the process.

If you choose Cigna, you can only use Atlanta Medical Center, Emory Crawford Long, or Northside for your surgery.  If you go to Cigna's website and put obesity surgery in their search engine, you should find a 35 page statement (#51) regarding Cigna's policy of WLS.  This spells out the requirements you need to fulfill to have WLS with Cigna.  If you chose Cigna, you could potentially begin the process now...start meeting with your PCP for monthly visits with accurate documentation, etc.  They will not make you start over January 1st as long as you follow their guidelines.

The other thing is that both companies will cover Lap-Band and Roux-n-y.  Cigna also covers DS and BPD (I think).  I don't remember if UHC covers the second two.  They will not cover VSG or some other lesser used procedures.

I hope I've helped clarify things for you.  If you have any questions, feel free to PM me, I think I have most of the basics down.  For those of you who have been following me in this process, did I leave anything out for LaShelle?

-Elli "the Goddess"