New Insurance Exclusions?

Does anyone know how I can be sure if our policy next year will cover WLS?  The 2006 summary plan description covers weight loss surgery and I am on my last month of my 6 month diet, which is the only requirement I didnt have.  My employer has sent out the changes with our health plan such as deductibles and premiums, etc.   But  no where does it say anything about the WLS coverage changing and I cannont find a summary plan description for 2007.  Everything has been submitted to Aetna and I am trying to get approval and surgery before the end of the year, but if that doesnt happen, how can I be sure they will honor that next year.  Any help would be greatly appreciated!  Thanks and Happy Thanksgiving !

I am in the same boat you are. My six month diet is up in January. A few weeks ago I called Cigna and they told me that they did not have any info on my 2007 plan and they suggested that I call my employer. For some reason, this made me nervous. In  my head I was afraid that if they knew what I was trying to do, that they would run and exclude it or something. I decided to email my employer to ask for the plan summary (instead of the standard "brochure" they send out.) I never heard back from them, so I call HR today. The lady on the phone basically wouldn't send me the plan summary. She kept saying there was no reason for me to need it. I told her I wanted to know about exclusions and then I made up a few ... braces, chiropractic care ... WLS. She was very adament about the WLS. It is ONLY covered when medically necessary and then she added "And it is hardly ever medically necessary and even then it is hard to get approved." Agh. Can someone talk me off the ledge I feel like I'm on?? Please tell me that, even though we are in open enrollment, that my company can't change the plan and make it an exlcusion.  My advice to original poster is to simply ask for the summary plan ... that way you have it in black and white.

your company can change there coverage anytime b4 open enrollment and not to say you are over reacting because i would probably be thinking the same thing BUT.... the woman in HR who is ANSWERING PHONES! lol has no say in what your health insurance will and wont cover the person or people who decide what is and is not covered are probably people who you will never speak to and who have no idea what is going on in your life... Most companies that cover weightloss surgeries are fairly big companies and they cover it becuase they made the choice to cover it and obviously someone there feels that it is nec. To be honest your post made me a little angry i hate how people treat overweight people and who the hell is she to say it is hardly ever med nec, she is not a dr... she is JUST answering phones in HR actually every single procedure that is covered through insurance is based on medical nec, i hardly think she is in the position to be saying what med nec means for every proc and how often it is considered med nec. Usually in fact almost always if a company is making a big change such as excluding WLS when it has been previously a covered benefit they will ad into the letter with your new premiums that the coverage will also be changing so chances are that its not... you do however have every right to a 'certificate of coverage' which is where this would be stated tell the woman in HR that your dr requested it she has apsolutely no right to question that well anyway sorry i wrote so much but just reading that post made me mad! lol goodluck I'm sure everything will work out! Also if your coverage is changing then you can usually call CS in december and they will be able to quote a benefit for the following year.

Shooting Star: Thanks for your reply! Through some research, I "think" I might be ok. From what I have found out, although this is very un-official, since the company is in the midst of the two-week open enrollment period, they cannot make changes to the coverage. I guess that they have already negotiated the contract with Cigna at this point. Does that sound right to you? I still cannot get the certificate of coverage. I called again (tried to change my voice in case I got the same girl haha) and this time they told me it was on our Intranet. When I told them I had not seen it on there, they told me I would have to spend some time "searching." Hmmm .... seems to be a secret. When I call Cigna, they tell me that they can only discuss my 2006 plan with me as it is my current insurance. They claim to have no info on my "future" insurance. I can see some logic in this ... but will all of the fooling I have done with Cigna, my gut doesn't trust what they say anymore. Thanks again for responding. I have been freaking out. I really thought HR was out to get me!