Cigna SHBP questions

Hi,

I switched to Cigna SHBP HRA last year in hopes of having surgery. However, my husband lost his job and it had to be put on hold. He has started a new job after over a year out of work, so now I want to get back into the process. I have a couple of questions though.

1) For those that have the same insurance, can you give me a ballpark figure of what you had to pay out of pocket? I have the family HRA coverage. I know it will vary somewhat, but insurance is something that confuses me, and I can't figure out a ballpark figure so that I could possibly set up a HSA account during open enrollment.

2) I know there is a document that is specific to Georgia about the requirements to have WLS, but I can't seem to find it. Can someone tell me exactly where to find it? I've looked all over mycigna website and can't find it.

Thanks so much!!

I also have Cigna SHBP. I would first suggest that you call them (call the customer service number on the statements you get every month from Cigna). Tell them that you are trying to determine EXACTLY how much you you will have to pay out of pocket next year... trying to set up health spending account, etc..... ). They can tell you exactly how much you will be out.

I too have the family HRA coverage, and they were pretty on target---- except that is only if NO ONE ELSE in the family goes to the doctor for anything other that the annual check-up. ( those visits come out of your HRA funds, which means you may have more to come out of pocket). It is VERY complicated--- and I STILL do not understand the HRA completely-----as I stated before, if you call them.... they can give you the exacts on how much it will cost.

I too set up the HSA, and did not have any additional "cash" out of pocket, and I have a little bit left over.

As for the guidelines for surgery, (copied directly from Cigna website).....

CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met:

The individual is

• Failure of medical management including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietitian for a minimum of six months without significant gaps. The weight-management program must include monthly documentation of ALL

≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:

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a BMI (Body Mass Index) ≥ 40

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a BMI (Body Mass Index) 35–39.9 with at least one clinically significant comorbidity, including but not limited to, cardiovascular disease, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension

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weight

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current dietary program

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physical activity (e.g., exercise program)

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an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CAPT codes

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a separate medical evaluation from a physician other than the surgeon recommending surgery, that includes a medical clearance for bariatric surgery

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unequivocal clearance for bariatric surgery by a mental health provider

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a nutritional evaluation by a physician or registered dietician

Bariatric Surgery Procedures

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When the specific medical necessity criteria noted above for bariatric surgery have been met, CIGNA covers ANY of the following open or laparoscopic bariatric surgery procedures:

Roux-en-Y gastric bypass

• adjustable silicone gastric banding (e.g., LAP-BAND®, REALIZE™)

• biliopancreatic diversion with duodenal switch (BPD/DS) for individuals with a BMI (Body Mass Index) > 50

• sleeve gastrectomy (SG)

• vertical banded gastroplasty

CIGNA covers adjustment of a silicone gastric banding as medically necessary to control the rate of weight loss and/or treat symptoms secondary to gastric restriction following a medically necessary adjustable silicone gastric banding procedure.

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Programs such as Weigh****chers^{®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietitian and detailed documentation of participation is available for review. For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.}

Sorry for the delayed reaction, I was out of town for a minute, but chesk out the post I sent Martina about shbp Cigna. Hopefully that will help you.