Needing Advice Please

Thank you Lee Ann for your support & great advice!

Bridget is who I finally spoke to yesterday when I called the office -- the first time I called it was someone else, who sent me to her boss, who in turn wanted to send me to someone else. (yadda, yadda)  Bridget was GREAT help and smoothed many "ruffled feathers" that I had.  She was even sweet enough to give me her direct phone line & told me to call her whenever I had any questions/concerns.  'Thought that was extremely sweet of her.

I've been taking notes; as I have been a "lurker" in here for a while, trying to do my homework, and that's one repeating suggestion.  Vicki being the second "tip" ... lol

Have a wonderful Thursday & try to stay warm!
*hugs*
Libby

OK Libby I just woke up so bare with me.  I have read what you posted and the responses.  Everyone is correct:  First I assume CIGNA is through your employer?  and Anthem is possibly through you spouse?  

1) Call Cigna to see if you have coverage for WLS or if you have an exclusion?  If they say no then go to step 2

2) Call Anthem to see if you have WLS covered or not?  If yes then you can assume the lapband is covered barr you meet the requirements and etc.   Even though CIGNA is your primary USA Dr. Rodriquez will have to submit to CIGNA to get the denial then forward to Anthem showing that CIGNA excluded WLS under your coverage.  Ask Anthem what the benefits would be as far as what your out of pocket will be.

3) When I had to have the Deep Vein Thrombosis ultrasound I was told that it probably would not be covered but the little sheet that I got from Dr. Rodriquez to take to my family dr. specifically had the test and what the reason for having it was so my family dr. could put the diagnosis of rule out deep vein thrombosis and it got paid when my family Dr. submitted it for payment.

4)  All correspondence with the insurance companies you have log the time, date, who you spoke to and keep that.   You as LeeAnn said are your best advocate.

If you have anymore questions don't hesitate to ask me you can email me or PM me.  My email if you want it PM me and I will give it to you

Vicki

Good Thursday Morning Vicki!

I'm going to try to answer your questions in the order you asked -- I too am just getting up so please ask if I am not making sense.

Yes, Cigna is through my employment - Anthem is through my husband's (retired GE).

Cigna does not cover anything concerning obesity - including Dr. Rodriquez's office visit.

Anthem does cover WLS, as long as I have followed the required tests. I have not asked what my out of pocket would be - will do that, and should have thought of that already.   Paying part of it isn't a problem, but like anyone else, the less out of pocket is always the way we'd like to go to save money (to buy new, smaller clothes!).

I'm assuming the "Deep Vein Thrombosis" is the same testing on the sheet that Dr. Rodriquez had me give to my family doctor. The doctor kept that sheet to put in my records.  All I know is it's a test to look for any blood clots in my legs.  Whatever the case, the reason for the testing was put in as obesity.

It seems, if you don't mind, that I might need your help in the future.  Sorry for sounding stupid - but that the heck is 'PM-ing 'you?

I spoke to Bridget yesterday and have to say she was MUCH help - so glad that I took the suggestions of calling to find out what's going on & where to go.  Much relief off my shoulders.  I also discovered that I haven't been approved as of yet, and won't be until after all the testings are done, which she said these are the last of all of them.  I go for the "scope" next Tuesday.

It makes sense about them submitting to Cigna first - at least with Cigna sending me rejection letters I won't be discouraged and will be expecting the letters.  I just figured since they already know that Cigna won't cover, that they would send to Anthem.  Porotocol.

Stay warm today & thank you very much for your help!  I honestly had thought about contacting you, but didn't want to just contact you "out of the blue".
*hugs*
Libby

 

vicki rocks Libby. she knows her stuff!!
dawn

Thanks Dawn - but I also think all of you girls have helped me as well.
All you ladies rock, and I'm soooo thankful that I wrote & asked for help!

*hugs*
Libby

Libby, if your bariatric doctor's office said you are cleared-you are.  I had mine through Anthem as well and they are very strict about coverage and the insurance person at your bar. doctor would NEVER go ahead if you didn't have clearance-because they too will lose money.  Family doctor's are not in the know of all the things approved or disapproved if it doesn't affect their pocket book.  Call Anthem to make yourself feel better.  Also, you should get a letter.
Sonja

Hello Sonja!

Yes, I've soon come to realize that that.  And neither does the other place where I have to go for my "leg scan"; as it was the lady there that was telling my FD that I wasn't going to be covered.

Many thanks for your advice & note ... it helps.
*hugs*
Libby

Libby,

Looks like your questions have been answered!
Just wanted to say, best of luck to you.

Leslie  :)

Thanks Leslie for the sweet note & wishes!

Gosh, this takes f-o-r-e-v-e-r to get going ...
It's the longest foreplay I've ever had! lolol

Enjoy your day & stay warm
*hugs*
Libby

Good luck and keep the faith. Vicki is VERY knowledgeable so call that insurance company.

Praying for good JU-JU for you!!