From Cigna to UHC

I'm getting ready to switch insurance from Cigna (who has denied my surgery due to a 6 month diet) to United HealthCare. I was wondering if anyone has UHC if they know what they require to approve?

I have United Health care for the second time And both times Have had an exclusion Policy. The employer says it's covered and United says it's not. This is the 3rd time being denied by them. you need to talk to Benefits to see what they need or if it's covered

Uniteds requirements are BMI of 40 or 35 with co-morbid conditions. The biggest issue with United that I see is that many policys have exclusions. You just need to call and see if YOUR policy covers it or not. Good Luck!! Erica

Hi Keli Just wanted to let you all know that I was approved by Cigna today without the conference call with Gary Viscio's help. Now have to call Dr. Blackstone's office to get a date. I'm doing the happy dance this afternoon, but I was in the same situation. Went to the insurance fair at the UA yesterday and was told the criteria is the same as Cigna's according to the TOC people. Make sure you put on your TOC that you are in appeal with Cigna. If you sent it in send in a revised one. This is what I was told by Orchard, the state told me something totally different. They want you to give up, keep fighting them. I know it's short time, but you should get your appeal off pronto. I was told that they will have to resubmit it through the new insurance when I get my approval letter. Deanne

Hi Deanne, Thanks for the info. I checked with the State Benefits people and they told me that I would have to be re-approved through United even if Cigna approved me now. I didn't file an appeal as I figured it was useless at this point. I was planning on starting with UHC in October. I asked about the "exemption" possibility and was told by AZ Benefits that UHC will approve if determined "medically necessary" and that the procedure is not excluded in our policy. This better be true or I'll be pissed. Thanks for the info on the TOC though. I wasn't going to submit it but I'll dig it out and send it in. You still think I should appeal through Cigna?

Keli, Hello. I am new to this process and also a state employee. I spoke with Tish at Dr. Blackstones office and she said she had heard that effective 1/1/2005-none of the new State plans were covering the wls. If you have heard different-please post.

Hi Amy, I specifically called the ADOA Benefits office and asked about this surgery being excluded. I was told ( and have in writing from them) that this surgery is covered if considered "medically necessary". It won't surprise me if they discontinue this surgery because they don't want to pay for it. I would think that they would have to "grandfather" us in for the surgery even if we get scheduled after 1/1 since we are already in the process and have been for some time. I was already denied by Cigna once so I'll have to see what UHC says in October. Let me know if you find out anything else. Thanks.

Hi Keli, I'm an AZ State employee too, and was just told yesterday by the ADOA Benefits office that yes, the surgery is an exclusion unless "medically necessary." I would be very interested in getting a copy of whatever you have from ADOA Benefits. It would be good to have it in my paperwork. I selected Schaller Anderson EPO, and I'm pretty sure they're not going to approve the surgery, let alone Dr. Blackstone at the Scottsdale Bariatric Center, but I'm going to try anyway. This Sunday at 1:00 I'm going to her seminar, and Oct. 19th I have my first appointment with my new PCP. I had all Cigna doctors, so had to find new ones. Where did this rumor about the State cutting off all WLS on January 1, 2005?