How Many SHBP People having or had wls this year?

Well, let's see...I had a pre-op visit with the surgeon that was billed at $135...don't know what Cigna is paying yet.  But otherwise, the aftercare with him is covered. 

If you are referring to pre-op testing? 

Pulmonologist charged $417.00/Cigna paid $264.64

Upper GI hospital charge $631.00/Cinga paid $340.74
Upper GI physician charge $142.00/Cigna paid $64.60

Cardiologist initial visit $434.00 (included EKG)/Cigna $223.22
Echocardiogram & Stress test $806.00 & $302.00/Cigna $362.70 & $116.56

I included all my pre-and post op testing 6 mos diet visits, surgery, everyhing in my estimate.

Oh, no! That should not happen. If the surgeon is in network, then everyone who works with him should be considered in network as well! I will make sure I address that when I go in for pre-op!

I'm almost finished the process (last dr. appt. this week, and last support group meeting next month). I'm still on the fence, I'm leaning towards RNY...so that will be about 24,000 grand. If all goes as planned I should be able to have surgery in Aug. I don't think our actual medical costs actual impact the state. The cost comes in providing the "rider (option)" for bariatric surgery on our insurance plan. The rationale for covering one lifetime surgery is that a lifetime of expenses for someone for someone morbidly obese is substantially higher.

Wrong.  The SHBP is a self insured plan.  That means the State pays every single red nickel.  Cigna pays NOTHING.  SHBP pays Cigna  (& UHC) to MANAGE our benefits.  But the State pays everything.

All our premiums, as well as whever the State kicks in for each of us goes into a big pile to pay for all insurance claims.

My mind must be on vacation as well this summer. You're soooo right. I do think it's a good investment for the state though. I have a sneaking suspicion that next year bariatric surgery may not be offered. I hope it is though!

Hey, I still haven't had surgery yet.  But I am getting close to it.  I sent in all my paperwork, but a woman called me back and said that I needed to have something on all my clearances that I was "medically cleared".  My PCP said, fine.  Wrote me a letter.  The cardiologist wouldn't say "medically cleared", but said I was fit.  I had the PFT done, it was read by a pulmonologist and signed by one.  But now I have to go to him, so he can write me a letter saying "medically cleared".   Will it ever end?

But having said all that, I have met my deduct able, used all of my HRA money...so I am not sure how much more all of this is going to cost.  I increased the amount of money I had on my spending acct, but that's about gone too.  It's just June.  What does it mean when you've reached your deduct able?  Does that mean you only pay the 10%?  Insurance confuses me!

Also, for someone who has UHC...what kind of UHC do  you have?  A young woman I work with (Actually in Atlanta) has UHC PPO.  She said that she had an exclusion in her plan.  Does anyone know about that?

Thank you all for your help...
Lisa

You have a $2000 out of pocket max. Once you spend that you pay $0 for everything!  Great considering the surgery will take you over $2000.  So the rest of the year everything is FREE.

After the deductible, you will pay 10% in network and 40% out of networ****il you get to $2000.  So if you go to the doctor and it's $1000, your copay will be $10.  I recently picked up a prescription for vitamin D and it was about $.50 cent. That was cool! Before it was about $20.


As for the other question, only the HRA and high deductible plans cover wls. Your friend is correct.  The other plans do have exclusions.  So, if you didn't pick the HRA or high deductible, you'll need to wait til January (if they still cover it next year).

If you weren't lucky enough to find out before November 2008, you missed out.  I accidentally found out when I called Cigna customer service during open enrollment for a general question last year.  For some reason (I guess it was GOD's intervention), she asked if I would be interested in wls. I don't even know how this lady knew I was fat cause I had BCBS at the time and they didn't have my medical info. I don't even remember giving her my name.  Otherwise I never woulda  picked an HRA.  She was the one who told me they were adding the new benefit.  I thank God for that lady.


Your frined can go ahead and start her pre-op testing to speed up the process. She will need the 6 mos diet and support groups. I'd start that in the next month or so. That way in January she'll have all of that out of the way.   The PPO will cover those visits, just not the surgery. 
She can also start going to seminars, so she'll have the surgeon picked out.

I pray they still cover wls next year. There are so many more people who need this and just didn't know it was available.  They are cutting budgets for everything. I hope this isn't something they cut.  So many state employees, at least at the agency I work for, are morbidly obese.

That is what I told the young woman I work with.  She should start NOW doing all of that other mess, that way she will not have to wait. 

Thanks again for all of the great information!