Confused, as usual....

Okay, my insurance company manages what gets paid and WLS is a covered surgeron if the guidelines are met.  I was told by my benefits department that WLS is excluded and why there are guidelines that have to be met.  I'm confused now, if Cigna is telling me that WLS is a covered surgery and will be approved if all the guidelines are met, why would benefits tell me it's excluded?  I think the gal I spoke to is confused and she's confusing me.  I was told by benefits that very rarely is anyone approved for WLS and "good luck" to getting approved.  Does this mean that even with all the guidelines met, I'll still be denied and then have to do the appeal with my own company? This is getting so disheartening.   Thanks for your input and help.

Get the list of requirements from your insurance company.  ( Mine was 3 pages long)  Then cross off each one as you complete.  I also gave a copy to my Surgeon and PCP.  That way everyone knew what we needed.  After almost 2 years I was approved last week. Don't give up.  Don't listen to the negative comments.  I also heard them from people at work too.  Be strong...  Make sure you call insurance and verify they have all your papers.  Mine never the the 1st fax.  But I straightened that out quickly.  ((hugs))

Keep fihghting them, and do NOT go to your boss or human resources. Human Resources is NOT your friend, nor are they ever going to be on your side. Deal only with the insurance company and do not sign a HIPAA release for your employer to obtain your personal medical information. If you live in an "at will" state, your employment could be jeopardized. The only way to by-pass it (and you would need to mind your Ps & Qs) is to have your spouse fight with it on your behalf. If you live in an "employment at will" state, basically you can get fired because your eyes are brown and they want a green eyed employee.  Insurance costs have risen at the rate of about 12% annually nationwide, and there is no employer that wouldn't want to save a few bucks. Fire the obese and they feel like they save money because of the increased insurance costs.  Trust me, you wouldn't believe the hell I have been through with my husband's company. They are out to justify their paperwork shuffling and if they can save the company a few bucks, they will do it.  The problem is, more than likely they will cost the company more money because they seldom put a dollar value on long term savings through better health.