Cigna OAP

Hi Everyone ... Newbie here! I hope that you're all well!  I'm currently in the pre-approval stage for WLS. I have 2 more appointments left with the dietitian and my paperwork can then be submitted to Cigna for approval. I was told that my insurance coverage for WLS is as follows: $1,000 deductible and I'm covered at 80% until my $6,000 out of pocket max has been reached. 

Does this mean I will only need to come out of pocket the $1000 in order to have the surgery? Surgery will be performed at a Center of Excellence facility; Emory Johns Creek Hospital. Thanks so much in advance for your response! 

~Tisha~

No, it means you will have to pay more than $1,00, but NO more than $6,000 (or $7,000, see below).

Let's say the surgery is $60,000 for everything (mine was $66,000).  You will have to pay your $1,000 deductible, then 20% of $60,000 (which is $12,000), but you max out at $6,000, so you will have to pay $6,000.  The only caveat is that I do not know if your deductible counts towards your out-of-pocket maximum or not, so you might have to pay $6,000, or you might have to pay $7,000.

You could always call your insurance and ask them if they have estimates for your portion for this type of surgery. 

Good luck!

Thanks so much!!!! :) I will keep you guys posted! 

I have Cigna OAP and my deductible counts towards my maximum out of pocket. YMMV though.