Question:
BEST AND WORST INSURANCE FOR WLS APPROVAL???????
hi, i have cigna and am at the very beginning stage. i havent seeked an approval from them yet. i might be starting a new job soon and might have to switch insurance. but the insurance at the new job might be worse than cigna so i might have to keep a foot in the door of the place im working at now just for the insurance....wheewwwww! anyone have any approval info on what would be considered best and worst insurance? — lisa A. (posted on June 26, 2003)
June 26, 2003
Each insurance company has many policies that the employer can buy, so it
can be the same insurance company but have an exclusion. I had one of the
best insurances in 95 for wls, but my company bought a cheaper version so
there was an exclusion.
— ZZ S.
June 26, 2003
I had the best insurance company and plan-no questions asked! I have Aetna
USHC with the employer as the State Of NJ. Believe me-no problem at all!
— Jackie S.
June 26, 2003
I have Blue Choice Option (which is NYS Medicaid). They FINALLY approved me
but put me through nine months of hell.
I had approvals from everyone all along the way. Everytime someone
approved, "well, we really want you to see such and such". Geese,
Horse's A's. But at least I finally got through the process. They made me
work and sweat for it every inch of the way though.
— Danmark
June 26, 2003
I think Fortis is the WORST and Anthem is the BEST. I was denied by Fortis
(they never approve it for any reason) and approved by Anthem in less than
2 days from submission. Good LUCK!
— Kymberly H.
June 26, 2003
I had great insurance CBA-Alliance PPO. Once the tests and required
paperwork was presented, they approved me the same week. I have a friend
who has Kaiser and it has taken her an entire year to get approved, and she
was never denied. Their pre-approval requirements had alot of hoops and
were very stringent.
— M B.
June 26, 2003
I have BCBS FEP PPO plan. My request was submitted on 6/25/03, I got my
approval over the phone on 6/26/03.
— tigerpaws
June 26, 2003
I have Blue Sheild/Blue Cross PPO (i live in CA) and they approved me w/ no
questions in 5 days! I heard Kaiser is very difficult! Keep in mind if you
choose a PPO you may have fat deductable !!! mine was $2,500
— E. V.
June 26, 2003
Hi! I have BCBS PPO and they paid for my sugery 100%. EVERYTHING!! My only
out of pocket expense was $20 for two surgeon visits! Since I was the
first person in Michigan to have Lap RNY through BCBS PPO, it took them a
bit longer than it does now. Six months after my surgery, my husband had
his, and he was approved in 24 hours. I've heard that Kaiser was easy to
get approved through and I've heard it was difficult. Either way, I wish
you much luck! Look at my first profile under Sharon Brittain if you want a
kick butt insurance letter that I know has helped over 100 people get
approved, too! :~)
— Sharon M. B.
June 26, 2003
Worst? Regence Selections in WA. Won't cover ANYTHING remotely related to
weightloss, even follow up care like bloodwork. Best? I had Options Prime
and I was approved in 2 weeks with NO testing!
— Kris T.
June 26, 2003
I have Aetna USHC HMO and had absolutely no problem with them. Approved
1st try. I did have everything they could have asked for and more though,
I did my research on their website for what was needed. Hope this helps
— Robin V.
June 26, 2003
CIGNA PPO - they will ask for everything but your first born child and
still will deny you. There are 38 of us in Houston still on appeal. I don't
even have an exclusion for WLS in my policy and they are still trying to
deny me the surgery! Good Luck
— Sunie I.
June 26, 2003
Cigna used to be fairly easy but since around february they upped their
diet requirement and have been denying almost everyone.They are ending
their contract with the state supplied version of cigna soon because they
have lost money on it.So I'm wondering if they are having financial
problems.
— jennifer A.
June 26, 2003
UHC PPO is one of the best, barring having the surgery listed as an
exclusion by your employer. I was approved in 2 weeks, and went in for it 5
weeks later.
— mellyhudel
June 26, 2003
... I forgot... I only had a 200 deductable. They pd for 100% of a 23,000
surgery.
— mellyhudel
June 26, 2003
I have Anthem BCBS of Virginia and they approved me with a phone call.
They're the greatest. All you needed was a BMI over 40 and that was enough
for them. My case manager even told me so.
— lindadougherty
June 26, 2003
UHC-PPO here and i had an approval in 2 weeks. it was around the easter
holiday as well, so 2 weeks i thought was great! i never called or emailed
or wrote them anything. i just waited. i have nothing but great respect for
them! i had Cigna-PPO before UHC and i hated them! even basic Dr's visit's
they always hounded me for more info and never wanted to pay? basic
stuff!!! i would always get a letter in the mail, something wasn't to there
standards, need more info, etc. i have yet to get one of those from UHC and
i have been to the hospital (ER) once, had WLS, few check ups, PCP visit...
they always pay- no hassles! I Love UHC-PPO!!! Cigna is the worst, in my
opinion. My best friend was denied on cigna-ppo as well... and she has a
ton of medical & health problems and a BMI over 50! go figure...
— heather S.
June 27, 2003
I didnt see it listed here in the worst so thought I would add it. I had
First Priority and live in PA, they have a very thorough exclusion policy
stating any type of inpatient or outpatient treatment for weight loss
including surgical treament for morbid obesity is not covered regardless of
medical necessity or comorbities. I now Have BCBS Special Care, and they
say its covered as long as the guidelines are met, but I am waiting for
approval 2 weeks so far.
— lillbitofsin
June 29, 2003
Well I have Aetna Hmo, and they put me through two years of hell. But I
finally got approved. I was going to tell you even if you quit your job,
you can ask the insurance company if they have a cobra plan, which is where
you still have insurance for the rest of the year even if you don't work
there. Oh it is more expensive sometimes. Hope this helps.
— Saleen98
July 1, 2003
I have Cigna PPO, and I had my initial consult 1/31 of this year, was
approved on the first try on 2/14, and had surgery 3/18. Not the least
problem with them. The kicker is, do you have PPO or HMO or EPP?
— Becky K.
July 2, 2003
I have Cigna ppo and have been waiting since May 22 for an answer, They
lost my file twice which wasted a month and I just found out about their
new criteria that they want weekly weighins with you pcp for 6 months!!!!
I'm dreading hearing my decision whenever it finally comes!!!!
— mary M.
July 3, 2003
I have Pacificare and I have been SOOOOooooOOOooo happy with them. I have
never waited more than 48 hours for ANYTHING be it a referral or approval
for my surgery.
— Sarah S.
October 3, 2003
The Worst???
Cigna, hands down.
They want 2 26-week professionally supervised diets and a whole buttload of
clearances from psych and a dietitian as well as your doctor. That in
itself is pretty bad, but I know people who have sent them ALL of the above
and then some and were still denied.
— April S.
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