I need SERIOUS HELP and ADVICE!!!
The health insurance plan on my job is self-funded. For the time period of July 1, 2006 through June 30, 2007, the exclusion in reference to WLS states "no coverage for obesity unless medically necessary." I was able to see a new book today and the new exclusion says " Medical and surgical services intended primarily for the treatment or control of obesity, (weight reduction) such as bariatric surgery and gastric bypass." This new exclusion is to be effective 07/01/2007. I have only two more weigh ins left with the last one falling probably in the middle of June 2007. I started the diet with my doctor in December 2006. Technically I already have 5 weigh ins unless the first one is counted as a consultation. Could someone please tell me what I need to do. I have done everything else required. I am worried sick about this and am waiting on a call from my surgeons office. Can I count the December visit? I have CIGNA but again it is self-funded. Someone please help! I know I won't get any sleep tonight...HAS ANYONE EVER HAD THIS HAPPEN TO THEM? PLEASE TELL ME THE OUTCOME!
Try to get it approved now. It is medically necessary. Get your doc to write a good letter, detail your diet history and get this done before this policy expires
KEEP IN MIND. Cigna knows the story and theyre going to stall you and delay things until 7/1. Don't let them
Gary Viscio
www.ObesityLawyers.Com
RNY 7/1/03 -166lbs
www.ObesityLawyers.Com
RNY 7/1/03 -166lbs
Last night after I posted, I did some more research concerning this change. On January 31, 2007, I went to HR to ask for the book that tells us what is covered by our insurance. Well they were very evasive and told me to look it up on our intranet. I did and I printed what I found there. I went back to look at it last night and it has been changed. The first wording said "Medical and surgical services intended primarily for the treatment or control of obesity, which are not medically necessary." Now it says "Medical and surgical services intended primarily for the treatment or control of obesity, (weight reduction) such as bariatric surgery and gastric bypass." I printed it on 01/31/2007 and it did not say that which means they changed it. The company where I work has an Employee Health Center. The FNP that works there is the person that faxed the referral to my surgeon's office. Isn't she their agent? She told me that this procedure was covered by our Insurance. Today I spoke with the patient coordinator at my WLS office. I was able to get in today to see my PCP for a weigh in. I am going by the WLS office tomorrow for the HPylori and then she is going to send for approval to my insurance company. I am so devastated that this has happened. I guess by asking HR some questions, I called attention to myself and now they are trying to stop me. I am all for seeking legal assistance. Where do I start?
Last night after I posted, I did some more research concerning this change. On January 31, 2007, I went to HR to ask for the book that tells us what is covered by our insurance. Well they were very evasive and told me to look it up on our intranet. I did and I printed what I found there. I went back to look at it last night and it has been changed. The first wording said "Medical and surgical services intended primarily for the treatment or control of obesity, which are not medically necessary." Now it says "Medical and surgical services intended primarily for the treatment or control of obesity, (weight reduction) such as bariatric surgery and gastric bypass." I printed it on 01/31/2007 and it did not say that which means they changed it. The company where I work has an Employee Health Center. The FNP that works there is the person that faxed the referral to my surgeon's office. Isn't she their agent? She told me that this procedure was covered by our Insurance. Today I spoke with the patient coordinator at my WLS office. I was able to get in today to see my PCP for a weigh in. I am going by the WLS office tomorrow for the HPylori and then she is going to send for approval to my insurance company. I am so devastated that this has happened. I guess by asking HR some questions, I called attention to myself and now they are trying to stop me. I am all for seeking legal assistance. Where do I start?