Cigna ins-Springfield area?????

Hey folks, I got a call today from someone with CIGNA ins who has a BMI of 51 and her policy excludes WLS. I'm actually on the phone with her ins now trying to see how I can help her....anyone with any tips who may have this ins and have had issues. Issue number 2 is if they will allow her the surgery, she'd hoped to have it done in Springfield. Has anyone had that luck with CIGNA? Thanks!

Tamara: I'm not sure if my story will hel*****t but here it goes. I have CIGNA Open-Access Plus thur my husband's employer. Previously we had Great West Healthcare PPO which did cover wls. We changed insurance effective 11/1/06 and was told all the benefits would remain the same. However, after 6 weeks in review was denied because "treatment of obesity either surgical or non-surgical was excluded." Instead of messing with CIGNA I called the Head of Human Resources for my husband's employer. She did some checking and called me back and said I was correct it had been covered under the previous plan and should have been included under the new plan. Her broker had to go back to CIGNA and have the policy amended. Within a couple weeks I was approved! Ask the person you talked to if her insurance carrier recently changed and if she knows whether or not wls was covered under the previous plan. Who knows could be the same story as mine. I'm still having to call CIGNA and have them resubmit the claims for processing. They paid the hospital bill, however, denied the doctor's charges saying treatment for obesity was excluded under the plan. I told them they had approved me for the surgery and had paid the hospital bill, however, it would be very hard to do the surgery without the SURGEON. GEEZ! CIGNA is in the process of paying the claims. Please let me know what happens. Debbie D.

Thanks Debbie, I'll let ya know how it goes. I do know that she's had the same plan for a long time.