Insurance problems - Prayers Requested

Hi, Everbody: I'm sorry I don't post often but I do read all the daily posts. It's just that we've been so busy lately, had a death in the family 2 days before Christmas, had a death of a Mother of one of the Scouts my son Luke is in, etc. I just wanted to share something with you all. My husband's insurance thru his Employer was Great West Health PPO which did cover gastric bypass if it was medically necessary and you went thru a 6 month doctor supervised diet and had a psych evaluation. I was finishing all these requirements the middle of October when we found out his insurance was changing to CIGNA Open Access Plan. Dena and I both called CIGNA the first week in November and we were BOTH told that the plan did cover it and it was NOT an exclusion. They had the same requirements as Great West did so they said I would not have to repeat them. CIGNA officially got all the records from Dr. Hornbostel on 11/27/06. Originally I was told it would take 10 to 15 Business Days before a decision was made. Then they told me it could actually take up to 30 business days. Last week they told me they would have a decision by January 11th. Well, in yesterday's mail I received the denial letter. The reason? That the both nonsurgical and surgical treatment of obesity were excluded under the plan. Needless to say I was disappointed. However, as I've said before I have asked the Lord's will be done. Not mine but His. That and having worked in the health insurance field for over 10 years I thought I'm going to call the head of human resources where David works. I did and she said she would look at the policy and return my call. This was yesterday afternoon. She returned my call this afternoon and said she thought she had good news for me. She said I was correct that WLS was covered under the previous carrier Great West and should have been covered with CIGNA. She said that they as an employer did NOT want to reduce benefits in anyway and it was not their intention for this to be excluded. She has talked to their broker and he is discussing the matter with CIGNA. She said it wouldn't be tomorrow but that she thought it would be taken care of and it would be covered shortly!! My guess is that either the broker or CIGNA didn't catch this and someone goofed. So we will see if once they get it all straightened out if they'll go ahead and approve me or if I'll have more hoops to go thru. Should be interesting. I have secondary insurance, however, would prefer to have both primary and secondary pay so my out of pocket would be very little if any. I'm still trusting the Lord and asking for his guidance. I have complete peace about it all. I believe it's all going to work out and it will at on His time table and not mine. I would ask that all you prayer warriors please remember me in your prayers as I do you in mine. Hope you all have a great Thursday! Take Care, Debbie D.

Hi Debbie: Got to love insurance and the games they play. Hang in there! Prayers are with you. Cathy

Debbie, My prayers are with you in your loss and also for the insurance. If you are having Dr H. (you talked about Dena) then I am sure they will work their wonders for you. I recently got my date but was fortunate that I was covered.I wish all these law- makers would truly work for the people they represent and make it mandatory for WLS to be covered. But most don't walk in our shoes. Take care and I wish you the best. Julia

Debbie, keep after them, call the HR Manager weekly till you have an approval letter in your hands. Don't let it sit on someone's desk like sometimes happens. Funny, I know His will be done, but we can help Him, can't we? ~Diana~

Debbie D, I will definitely be praying for you. I believe if your husband's HR person is involved that this will be taken care of and quickly. She has admitted to you that it was not their intention to deny WLS so that's pretty strong encouragement. I know it's in God's hands and that's the place for it to be but do follow up so they remember you exist. I know for a fact that I got my surgery approved because of my perseverence and compliance to every detail and the relationship I had built with the insurance approval person. My husband said from the first, make them like you, know you as a person, and don't ever tick them off and he was soooooo right. Love that man. Hugs and prayers, Lana

Hi-You are so inspirational. I think the thing is that you have Peace about it and I believe thar the Lord will reward you for your faithfulness. As I am sure you know He says in Matt and Mark that all we need is faith the size of a mustard seed that we will be able to move mountains. This weight is a mountain in my life and I know it is in yours as well. I know that you must be disappointed but God will work it out for you. As long as we do what you can i believe He meets us there. I just sent a prayer up for you and will continue to keep you in my prayers. ((((Hugs)))) Amy