The worst timing!

[MissMelo 2]

My employer will be changing from our current insurance, oxford, to a new insurance company, cigna. What the hell am I gonna do! I had no problems with oxford covering the lap band, but cigna is saying that they do not cover the surgery! I cannot have my surgery done before my insurance changes because I still have a few more pre op appointments. It is not listed as an exclusion with cigna, but they do have an exclusion for weight loss programs and the rep was saying that this would be classified as a weight loss program!!!:eek: That does not make any sense! What should I do guys! This is the worst timing ever! Please HELP!!!

[BillyTheBear 0]

Really no advice one can give on insurance policy or strings that can be pulled. I know some people are able to save and have the surgery done cheap in certain areas, so that's an option you can consider.

[purple3797 5]

Is there any way the pre ops can be moved up so you can have the surgery before it changes. maybe the doc will work with you??

[Cleo's Mom 257]

My employer will be changing from our current insurance, oxford, to a new insurance company, cigna. What the hell am I gonna do! I had no problems with oxford covering the LAP-BAND®, but cigna is saying that they do not cover the surgery! I cannot have my surgery done before my insurance changes because I still have a few more pre op appointments. It is not listed as an exclusion with cigna, but they do have an exclusion for weight loss programs and the rep was saying that this would be classified as a weight loss program!!!:eek: That does not make any sense! What should I do guys! This is the worst timing ever! Please HELP!!!

Talk to the doctors who would be doing your surgery under Oxford. Maybe they can move your appointments up and get your surgery in before the change takes place.

Even if they can't - don't take no for an answer. Appeal Cigna's denial. Ask for where in your policy it specifically does not pay for gastric banding surgery. Perhaps it will pay for it with co-morbidities. Weight loss programs are Weight Watchers, Dr. Dean Ornish, Jenny Craig, etc.. It is not surgery. Don't give up. They always say no at first knowing that most won't pursue it.

Good luck.

[MissMelo 2]

Guys, Thank You so much for the advice! I have an app with my surgeon on the 17th, I am going to see what he can do for me. I still think it will be a long shot to have the surgery before 1/1/11, but I'm hoping he can help me out in this situation. My human resource department said that while we are switching from oxford to cigna, that the benefits would not be changing. So if oxford would approve it, cigna should approve it. So what would prompt cigna to tell me that it is not a covered benefit? I knew all of this was too good to be true.

[spoiltmom 44]

Guys, Thank You so much for the advice! I have an app with my surgeon on the 17th, I am going to see what he can do for me. I still think it will be a long shot to have the surgery before 1/1/11, but I'm hoping he can help me out in this situation. My human resource department said that while we are switching from oxford to cigna, that the benefits would not be changing. So if oxford would approve it, cigna should approve it. So what would prompt cigna to tell me that it is not a covered benefit? I knew all of this was too good to be true.

Go back and talk to your HR department and tell them what Cigna told you. They should be able to clarify it for you.

Have you met all of Cigna's pre op requirements yet? Have they given you a letter of approval?

[MissMelo 2]

Go back and talk to your HR department and tell them what Cigna told you. They should be able to clarify it for you.

Have you met all of Cigna's pre op requirements yet? Have they given you a letter of approval?

I actually called cigna to find out their requirements for the lap band and before they even got to that part, the rep tells me that gastric banding is not a covered benefit. I told her that my employer does not exclude it, and then she says that they exclude weight loss programs and that would fall under a weight loss program! I was beyond pissed. That does not even make sense. I'm about 3/4 done with my pre op appointments but i'm still in the middle of my 6 month waiting period.

[Desiree1972 0]

How about COBRA - maybe you can use them for a couple of months? I am so sorry - how devastating. I understand why you are crushed.

[bayareanan 24]

I a pretty sure you cant do COBRA if you have a new coverage through your employer.

[MissMelo 2]

I was going to waive the new insurance and use cobra, but my hr department said that you cannot use cobra if insurance is being offered. The only other thing I can do is hope that my doc will try to fit me in for surgery before January.

[spoiltmom 44]

I a pretty sure you cant do COBRA if you have a new coverage through your employer.

Me too. I think Cobra only applies if you lose your job and then it applies to the current insurance company=not the previous one.

[samomom 19]

Just because its a new insurance company doesn't mean that you won't be allowed to have the surgery. Its your employer who dictates what is covered and what isn't. You can always ask for an exception. I would call the doctor and tell him whats going on. They can always make room for you.

[cjett 0]

I have Cigna and had no problems with them covering the surgery though I would be afraid they may make you start the 6 month process again.

[TKW 501]

Could you keep your insurance and pay the premium yourself. I know that is out of pocket expenses, but at least you could still have the surgery. Kind of a crazy way about it I know... but something to think about! Good Luck to you!

[honk 780]

If your HR team said there were no changes to the coverage I would go to them in person. You may need to speak with Benefits instead of an HR Generalist (depending on the size of your company) regarding this change to your benefits. If the old policy covered the surgery and there was to be no changes; this would qualify as a change. They may indeed have decided to not cover the surgery but that is a change and they should not sell this as no change to the benefits policy. Again some companies have specialized benefits departments if your company has one of those go to them directly. I am not talking about Cigna. You need to get someone at your company who knows everything there is to know about this new insurance policy. If you don't have a benefits department find the the highest level HR person you can find this may be an HR Manager, Director or VP. I am an HR Specialist (recruiting) and I know many HR people like to dodge difficult questions. You are paying for benefits and have a right to know what you are paying for.