What if my insurance is changing??

I will have my first request for surg letter sent out next week....What I'm worried about is this: In October our insurance will be involuntarily changed......Do you guys think I will be able to have the surgery before it changes? If not, how exactly could I keep my ins. co. (through self pay, etc.) in order to get the surgery? (I have Cigna PPO, who says the surg must be medically necessary) I have heard that Cigna is good about approving the surg...Anyone have any ideas, suggestions or words of comfort??

First of all, Cigna is notorious for denying WLS. They want you to have a documented six month diet with your PCP (not surgeon) showing how many calories per day, exercise, nutritional education, and behavioral modification. Secondly, do you know that WLS is a covered benefit under your plan? You can check online at www.mycigna.com. It just may be excluded. Finally, do you know who your new insurance carrier is, and if WLS will be a covered benefit under that plan? You have a lot of research to do... Best of luck, Roberta

Hi Roberta- Yes, I know it is not a direct exclusion, and that it must be medically necessary...I did NOT know I needed to have a recorded journal of daily food intake, etc......I was going off my surgeon's office counselor's comment that "Cigna has a good record of approving." Unfortunately, I have no clue who our new insurance will be with....WAIT!!!! I just went a checked again today.....How is Schaller Anderson's reputation for approving???? That is the PPO choice we have...We will be given 2 choices....An EPO Rural Arizona Network/Arizona Medical Network (RAN/AMN) and a PPO with Arizona Foundation (Schaller Anderson).........The new insurance is supposed to take effect in Oct.....Well, please let me know what, if anything, you know about that EPO or PPO provider...I'm going to go do some research now on Schaller Anderson.... BTW- do you know if I can keep Cigna as a self pay if Schaller has a bad rep?? Thx for the help Roberta!!!

That Schaller I was talking about? It's an EPO...We will have a choice between Beech Street, United Healthcare and Az Foundation for Medical Care for PPO's whereas we will have a choice between United Healthcare, Schaller Anderson and RAN AMN for EPO's......Maybe you have some prior knowledge or exp that can help out!!! I am desperate for this surgery...I know others may have more health probs or more actual weight on them, (I am 32 5' 2" tall and weigh 250), but I am simply not healthy....I used to have a real passion for life.....I want that back.....I want to be able to know that through dedication and hard work, I can get back to a manageable and healthy size in order to pursue my passions in life!!! Thx Much

Your coverage will be determined by your employer. It should be the same benefits no matter who the Administrative Services Only (ASO) contract is with. You should talk to your HR dept and see if they have a plan written. You will not be able to keep Cigna (under a Cobra contract) since you are not leaving the company, and you will continue to be eligible for insurance benefits thru your employer. Just curious, do you work for the State of Arizona? I know they are terminating their ASO contract with Cigna. Check out the Cigna Squeaky Wheels group on Yahoo groups for more information and support on Cigna. Fight the good fight! Roberta

Hi again...Actually, it's my hubby who works for the state! "Your coverage will be determined by your employer. It should be the same benefits no matter who the Administrative Services Only (ASO) contract is with. You should talk to your HR dept and see if they have a plan written." when you say that, do you mean that no matter who we get stuck with, they should provide the same coverage which translates to WLS? Or are you saying that I need to ask the HR dept to make sure that's a part of it, or?? Is the same exact coverage required??

Talk to HR...