Dilemma

Mvpo8961 · December 22, 2005

I having been reading for a while but am a new poster here. I have a dilemma and would like for ya'll to tell me what you think if it were you.I am 3 months into a 6 month supervised weight loss program. I have Cigna HMO ins. I have had my nutrition consult and almost finished with my psych eval per my ins requirements. The other night I applied for Capital One Healthcare funding for my surgery and was approved. The catch is the funding is good for 90 days only (I didn't know that when I applied). Now wouldn't you know that happened 92 days before my six month program is complete and can be submitted to my ins co. I called Capital One to see if the 90 days could be extended and was told that was a firm date. However, I could reapply after that. They suggested that I wait my 90 days and fund the surgery at the very end (this is done by signing the paperwork and sending it back to them). Then you start repaying 4 - 6 weeks after signing. This would give me time to submit to my ins co and see if I can be approved for ins coverage. Then I could just repay what was borrowed in a lump sum back to Capital One. Called the surgery center (which by the way is NOT where the office of my doc is) and found out they are OUT of Network for my ins. So I would have to go to the hospital that is in network for CIGNA.I can sign the papers and then wait 4 - 8 weeks to have my surgery and see if ins will cover and then reschedule to the hospital and hope the surgery center will refund Capital One. I either have to have the surgery in mid Jan or wait till mid April due to husband's work situation. If I self pay it will be 400.00 a month for five years. 1. I can have the surgery and get it over with and just grin and bear the payments. 2. I can sign the papers and schedule delayed surgery at the surgery center, submit to ins., if approved reschedule surgery to in network hospital and hope surgery center will refund to Capital One. 3. I can wait for my ins. (with no guarantee of approval) and let my Capital One lapse, then reapply (without guaranteed approval) So what would ya'll do? Myra

December 29, 2005

I know that you are wanting to do the procedure as soon as possible but my advice is to wait for the insurance. the finance company will aprove you again. They are going to encourage you not to wait for insurance because it is in their interest for you to borrow the money.

ladysplenda · December 29, 2005

I would wait too.That is alot of money.Why do you think you will not get approved?

Mvpo8961 · December 29, 2005

Mainly because I have CIGNA insurance. The office manager at the surgeon's says they have yet to have CIGNA approve a surgery. She herself had CIGNA and submitted for surgery, was denied, appealed and denied again. I just feel if the office manager of a bariatric doc ( who knows the ropes because that is her job) can't get it approved realistically what are my chances? Everyone I know says CIGNA is the second toughest ins after AETNA. I don't want to waste time for a pointless endeavor. Does that make sense? M

bubblesstina · January 3, 2006

i would also wait to see if you are approved before aking out a loan. I agree that it is in Capitol One's interest to have you go ahead and sign the papers. If they approved you they will again. Wait untill you hear from the insurance company till you tke a huge financial hit like that!!

Plus, you are going to need that 400 a month to go buy clothes!!

Iluvharleys · January 3, 2006

I would wait to see if the insurance will cover it too. Capitol One will always approve you again, and that certainly would be a lot of money saved.

Mvpo8961 · January 3, 2006

Thanks everybody. I tell you it is really difficult when you know you can get surgery just by signing a piece of paper. I think what I am going to do is see my doc Jan.6 and pin him down on how many CIGNA approvals he has really had. I am not going to wait a year to change insurance to another that might not cover it.

So when I see him Friday I will know if I am going to wait or not. My husband says to go ahead and have the surgery and not wait for ins. Nice to have family support which ever way it goes.

By the way I am an insulin dependent diabetic of 15 years and have high lipids and a BMI of 46. So I have comorbidities that make it a worthwhile effort to have the surgery ASAP.

DiDi · January 5, 2006

Mvpo,

Good luck. Hope Cigna wakes up & does what they know is the right thing to do. I'll keep my fingers crossed for you! Hang in there love, we're all with you.