Question:
Switching Insurance carriers - still need plastic surgery....

OK here's my problem. I got an email today from my employer that states that January 1st Cigna POS will no longer be an avaliable option (which is fine by me!) HOWEVER, I have lost 124 pounds and am in need of a tummy tuck, breast reconstruction & thighplasty -- all recently denied by Cigna. I'm not sure who my new carrier will be, other then its either Atena or United Healthcare... Would my need for reconstructive surgery be considered pre-exisiting? OF course I won't know the specifics of our contract with either of this companies until October 13th but I am wondering what I'm in for... Thanks, Kirstin    — lilmskitty (posted on September 10, 2003)

September 10, 2003
If you've had a year's worth of continuous health insurance coverage (e.g., you had coverage beginning 1/1/03 or before) and you've not had any lapses in the coverage, then there would be no pre-existing with the new carrier.
   — Patty H.

September 10, 2003
You are being switched due to your employer. It is rare there would ever be an existing condition clause involved in this sort of situation. We can change plans once a year with no pre-exist ever factoring in. That's the benefit of group plans. You should be fine in that respect but don't count on plastics being covered any better. I had a surgeon consult yesterday and he said it is pretty rare unless you have the skin breakdown and untreatable skin infections, which lucky me doesn't have. Nor do I have a hernia, so I'm probably on my own, which I will find a way to deal with. We will submit to insurance but I won;t lose any sleep worrying over if they will cover it, because it will literally be a miracle if they did.
   — zoedogcbr

September 10, 2003
CariAnn, I'll let you know early next year! I know my policy is changing a lot. It is quesitonable whether it would cover now, but who knows what next year brings. Many insurance companies that do cover WLs do not cover any PS unless you have the severe infections/rashes that do not respond to medication. Lucky me I don't! Oh well!
   — zoedogcbr

September 10, 2003
I had WLS with Aetna and then a year and a half later Cigna approved my lower body lift with hernia repair. To this day I thank my lucky stars that the PS was approved.
   — Pamela B.