need info please

I have just signed up to do the lapband surgery. I went through all the motions of Gastric Bypass a couple of years ago. Got frecked out never went through with it. Anyway my information meeting is March 5th in Manchester NH. Now i have been heavy all my life, my whole family has. My sister had Gastric Bypass 2 years ago and she looks great. So now i want to have the Lapband surgery. I have been with my insurance company Cigna Open Acess High Plan for 2 years. I received a referral from my doctor to do this and i called my insurance company and they said no we don't pay for any weigh loss surgery wheather it be medically necessary or not. Has anyone had this happen to them? I would hate to have to go trough all the motions again to have them say sorry but NO! What should i do? Should i call our broker, or should i just bring the information to the clinic and let them sort it out. I am just very impatient and need to know the answers now. Thanks

Hi Diane, congratulations on beginning this journey! I am going through the Dartmouth-Hitch**** program and they tell you right up front that CIGNA (no matter which plan you have) no longer covers weight loss surgery - STUPID in my opinion! You may want to explore changing insurance carriers so that the surgery is covered. Best wishes on this journey!

I looked at some of the members that used Cigna and they have on there site that they do cover it. I think they should cover it, the state of nh medicaid covers it, give me a break. My insurance is out of NJ because a part of our company is down there and i was hoping to see if the NJ covers it. They cover infertility, why not weigh loss. ITs amazing that these insurance companies want you to quit smoking and lose weigh and then say - sorry but your on your own. Well pay when you get older and start falling apart. I wonder if theres anyway to fight them on it. Hmmmmmmmm interesting. Thanks so much for your input, i'm not sure what i will do now we don't over more than one insurance. Thanks

Diane, Hello I feel your PAIN.....My old insurance provider COVERD the surgery. NOW, my employment changed providers to BCBS of NH and they said NO they don't cover...But can appeal their desion....Maybe that's something you can look into as well....I am calling my PCP to see what input she can offer if any....Good luck keep me posted and I'll kepp youa s well...We'll get through this Crap ONE way or another! Where in Nashua are you abouts....Nashua here to... Stacey

I asked our broker at work and he told me that if its an exclution then there is nothing i can do if they deny me, which they probably will. But i also read another post that said something about obesitylaw and this lawyer ( who has also had the surgery) could represent you if they think you have a case. I also read that Cigna said they were going to be actually adding that more to their health insurance plans because of the success rate. How frustrating. I have started the process all over again and need to go ti information night at the CMC on March 5th in Manchester. They said that if i still wanted to do it then they would get all my records from when i was doing it before and go from there. Well we'll have to see what happens. Whats most frestrating is that every year our company changes health insurance companies and its like starting all over again. WHATEVER!!!! (as my kids would say) I do know one thing i am a fighter and i want this more than anything. I live in Nashua on the way to Hollis, NH off of rt 111. Thanks for your support, let me know what your PCP says. Did you already have the surgery or are you waiting for it too?

You know Ive been thinking....after what I had to go through last week to get my surgery approved I think something really needs to be done. What Im not sure. I do know that after looking and reading alot it is in the best interest of these insurance companies to cover this. The cost to treat all the problems that come from being obese are more than paying to have this surgery. I know that when I went to the doctors office last week and spoke to Sue the nurse for the program she told me that its great that I went to head with Medicaid but what happends after that? So I won my battle but does that change anything for the next person? It doesnt. So what can I do to make a change? Been thinking about that. Some how need to get some attention about this. Maybe see if Union leader would run a story about it? Making calls to Concord...not sure but something needs to change. Its not like we are asking them to pay for us getting a bigger chest or a winkle free face....we want to live a longer healthier life. Give me some feed back on this....

Carolyn, I agree with you 100% we went from BCBS of RI to bcbs of NH and they ecluded it from their ploicy... I cried begged and pleaded and the woman just ssaid sorry it's not covered. I want this surgery to be healthy and able to do more without being in pain and easliy tired....I'm tired of the insurance companies that WE PAY DEARLY into, telling us NO! It's total EXCUSE me for a minute but BULL****! I'm behind you Carolyn 100% Stacey

Thanks for that PDF file, it offers alot of info thats very hard to find on the Cigna site. Well i received to paperwork from the obesity center in Manchester on Thursday. I called up the SNHRMC for Dr. Drinkwaters program and they are going to send my all of my file when i was doing the program with them. I have my doctor sending in the pre authorization form, i have to attend a meeting at the Obesity place on March 5th. I also sent to the insurance compay the questionare from the obesity center. I also have to have my doctor sent in a referral to the obesity center to go with this program. I am so excited. I am hoping to schedule an appointment right after March 5th. If i go in with all my paperwork they will know how serious i am about this. Maybe i can get it done by this summer. They also said because obesity runs in my family that you can get approved quicker. My sister had the gastric bypass a couple of years ago - she can now run 5 miles a day. I can't even walk a mile without huffing. I am also a smoker, i am thinking that i want to get hypmotized (however you spell it lol) to quit since i have done everything else. I am so excited.

Diane, NO I haven't had the surgery yet. I was just starting my journey. I had some appointments set up for the end of this month, however doesn't look like that will be happening....I am just so frustrated and depressed it's not funny . I want to be HEALTHY DAM IT !!!!! After all aren't we the one's paying the insurance companies WHO are they to tell us NO!

Are you seeing someone for your appointments in Nashua or are you going through the place in Manchester. I would love to do it out of Nashua closer to home. I also talked to our insurance broker who is in NJ and he sent an email to his contact at Cigna to see if they pay for the surgery. She said if NJ laws mandate they pay for it then they will. She also replied again saying yes, my doctor will have to start the preauthorizaton process. I called the doctors office and she will be putting something in my file and calling them or faxing them a letter for this. I am so excited!!! But does anyone know how to find out if NJ laws mandate the surgery? I just want to protect myself and have more in writing. Also does anyone know what the doctors need to write to them to get the authorization? Its weird because i have open access which doesn't require a referral, so i don't know how this will work. Because i have been through this program before the obesity center said they can get all my information from before and see where i was with it and maybe start from there. Any ideas anyone? Thanks