Cigna SHBP Member Approved for Plastics Woo Hoo!!!
For those shbp members interested in plastics, I thought I'd share her story, so you'll know what you're up against.
Ms Carley started out pre op very hippy with very thick thighs. She lost 100+ pounds with the rny, but was left with huge chunks of loose skin and excess chunks of meat in her upper thigh and knee area.
Her knees went out on her and she became wheelchair bound. She spent some time in an inpatient rehab center because she could not walk on her own or care for herself. They could not do the knee surgery because of all the meat and skin on her legs.
Even with all that going on, she had to fight Cigna 8 months to get approved!
Cigna paid for:
inpatient hospital
inpatient physical rehab
motorized wheelchair
in home hospital bed
physical therapy
chiropractor
pain meds
God knows what all else
But Still...
It was denied. She appealed, and went before a medical review panel with a group of doctors for a final appeal. She found out last week they have FINALLY approved it.
So, the point is Cigna WILL pay for plastics, but I think you'll have to fight pretty hard for it.
Ms. Barbara said she had lots of medical documentation from several specialists. So, definitely get a paper trail going.
Praise God for getting her approval. She really, really, really needs this. I am so happy she will be able to walk again.
Rockmart Georgia
HW: 315 CW: 117 GW: First goal 150 met 3/23/2012, Second goal 135
I am very happy for her, and I am praying that she will pull through ok. They have a LOT to take off her thighs. They will have to do it in 2 stages because there is just so much there. I know she will be in a lot of pain and she will likely be in an inpatient rehabilitation center for a few weeks post-op.
The fight she had to go through shows just how little State of GA cares for it's employees. They approve a Medicaid patient for plastics a lot quicker than they will a state employee.
And, it's not like state workers earn enough to be self pay either. Just ****** me off!
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I 
MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
!Be prepared for a fight. It took her forever to get an approval, and her excess skin is so bad she can't even walk!
Just be smart about how you work the system. You're paying for your insurance and they need to give you what's rightfully yours for your health and well being.
Just post us on every step, so others will know what to do too.
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
