Great News!!!
I just received an e-mail from the state office. The new benefits have been decided for 2010.
State Employees Will Continue to Have Coverage
for
Weight Loss Surgery
for
year 2010 !!!
I called Cigna and confirmed this is correct. So, if you had surgery this year, you won't have to worry about your follow up visits, lap band fills, etc being covered. WHEW!
Also, if you are trying to have surgery next year, you will have the option to choose insurance that will cover wls.
*** If you have not had surgery
yet, and will be seeking surgery
2010 please use the following
guidelines:
1. You must choose either the HRA or High Deductible plans for Cigna or United Healthcare when you choose your insurance for 2010. These are the ONLY options that will cover wls. ALL the other plans will not pay for wls. Once open enrollment is over, it will be too late and you will have to wait til 2011. If you, or a family member are even considering wls, go on and err on the side of caution and get the HRA or HD plan.
2. You will be required to attend 6 months consecutive support group sessions and 6 months consecutive physician supervised diet visits before they will approve your surgery. You can start this now even if you do not have the HRA or High deductible plan for 2009. This will give you a jump-start on the process. Be sure to document EVERYTHING you do!
3. Please stay tuned to the board for updates. There are several shbp members who were blessed to get wls this year. We were guinea pigs, since this year was the 1st year in a long time wls was covered by shbp. It was a long and hard process for us. Hopefully, they have worked all the kinks out of the program and you will have a smoother approval process. We will do all we can to guide you through this. Please post to the board what you are going through get approved, as it will be very helpful to others. We veterans could not have done this without relying on each other.
State Employees Will Continue to Have Coverage
for
Weight Loss Surgery
for
year 2010 !!!
I called Cigna and confirmed this is correct. So, if you had surgery this year, you won't have to worry about your follow up visits, lap band fills, etc being covered. WHEW!
Also, if you are trying to have surgery next year, you will have the option to choose insurance that will cover wls.
*** If you have not had surgery
yet, and will be seeking surgery
2010 please use the following
guidelines:
1. You must choose either the HRA or High Deductible plans for Cigna or United Healthcare when you choose your insurance for 2010. These are the ONLY options that will cover wls. ALL the other plans will not pay for wls. Once open enrollment is over, it will be too late and you will have to wait til 2011. If you, or a family member are even considering wls, go on and err on the side of caution and get the HRA or HD plan.
2. You will be required to attend 6 months consecutive support group sessions and 6 months consecutive physician supervised diet visits before they will approve your surgery. You can start this now even if you do not have the HRA or High deductible plan for 2009. This will give you a jump-start on the process. Be sure to document EVERYTHING you do!
3. Please stay tuned to the board for updates. There are several shbp members who were blessed to get wls this year. We were guinea pigs, since this year was the 1st year in a long time wls was covered by shbp. It was a long and hard process for us. Hopefully, they have worked all the kinks out of the program and you will have a smoother approval process. We will do all we can to guide you through this. Please post to the board what you are going through get approved, as it will be very helpful to others. We veterans could not have done this without relying on each other.
LaShelle,
Have you figured out how we are going to get the plastic surgery covered?????
Plastic surgery is covered if you can prove medical necessity (i.e. rashes) AND it is being done to correct a severe deformity. There is a different section that specifically states it will not cover plastics for people who have had WLS.
At 150 pounds down, I already see where I NEED the plastic surgery and when I'm finished losing a total of about 250 or so pounds, I'll be able to prove medical necessity and SEVERE deformity. I feel another fight with the State coming on!
-TS
Have you figured out how we are going to get the plastic surgery covered?????
Plastic surgery is covered if you can prove medical necessity (i.e. rashes) AND it is being done to correct a severe deformity. There is a different section that specifically states it will not cover plastics for people who have had WLS.
At 150 pounds down, I already see where I NEED the plastic surgery and when I'm finished losing a total of about 250 or so pounds, I'll be able to prove medical necessity and SEVERE deformity. I feel another fight with the State coming on!
-TS
Highest Weight/Surgery Weight/Current Weight/Goal
426.4/356/216.8/165?
Yikes! I have CIGNA too....I completed the psych testing, nutrition appt . and my one exsisting medical record showing that I was supervised by a doctor for 4 months (should be 6). The doctor that I had been seeing since 1990, destroyed my records! :( So I am just keeping my fingers crossed, given my age (44) that they will see that I need this....You can google CIGNA Weight Loss Surgery, and the information should pull up.
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