Cigna - SHBP

Nope, Elli you did great.  I too have been on the phone wih these companies for weeks as well.  I've posted a pretty good break down of the $ part of the HRA plan but I will gladly share what I've learned with you too.  Good luck and don't feel bad we're all basically confused and frustrated with this whole process.

Makeila M.

P.S.  I chose to go with Cigna.

So, Makeila,
Where is your HRA breakdown? Can you repost?
I am going with Cigna,too.
Susan

Post Date 10/17/08 6:35 am
Topic: RE: insurance

OK from what I've found out about the HRA plans (both Cigna and UHC work pretty much the same way)...  I spent hours on the phone having them explain this to me and this is what I was told....


Let's say the surgery you want costs $10,000.

Well first, b/c of the contract the dr's have with the ins. companies you would get a discounted rate... let's say $7,000.

Ok so the HRA would pay the first $500 which would leave $6500.

B/c you used up your HRA funds the next $1000 (which is the family tier deductible) would fall on you to pay... which would leave you a balance of $ 5,500.

After that deductible is met you would then pay 10% of what is left and the ins. company would pay 90%.. your 10% would be $550

So that means for the surgery you would pay around $1,550 out of pocket...

Let's say you have the surgery on Jan.2 (WE all wish!)

And then you get sick (allergies, cold, kids get sick, whatever) and you need to visit you regular doctor on Jan. 3...

You've used up your HRA... you've met your deductible already...

you would then pay 10% of the cost of the dr's visit (at the discounted rate contracted by the dr and the ins. company)...

So let's say the dr. visit costs a total of $80...

you would pay $8....

you would keep paying 10% untill you reach a total out of pocket max of $4500 for the year...

if you reach this amount then the ins. pays at 100% for the rest of the year..
 

Thanks!

I am leaning toward the DS procedure, but can't seem to find anyone at the three hospitals CIGNA allows that does that procedure. Have you found anything differrent? 

I have already scheduled my seminar meetings with Emory and ATL Med Ctr. They both have a limit on the number that can attend, so I suggest signing up asap.  I have also scheduled my 1st visit w/ my physician.


I was not aware of the 6 mos of behavioral counselling requirement.  Where do you find a counsellor?  I thought you had to just go 1 time.

The only surgeon that I know for sure that does DS is Dr. Dennis Smith.  He's not a provider for Cigna or UHC and I'm not sure what hospital he operates from.  He's in the Atlanta area.

As far as the behavioral counseling?  That appears to be a component only if you go with UHC, not Cigna.  And by behavioral counseling, I THINK they are referring to monthly visits with a nutritionist.  And yes, you do have to see a psychologist 1 time for an evaluation.

-Elli