Gwh- Cigna

[lrhodes46 55]

Anyone have Cigna and had them pay for the lap and surgery? My policy says weight loss is not covered for gastric bypass surgery. But I had my insurance verified by the patient coordinator and she was told its covered if I meet their criteria. I was also told since I have a high deductible (which has been net) that I might have to pay fit the lap and device itself. She said that runs about $5000.00. But since my deductible is met shouldnt insurance cover the device? I really can't afford the 5000.00 since I paid for shoulder surgery 4 months ago in full. Anyone had anything like this with insurance. I go for my seminar next Saturday then I get my free consultation. Just hate to go and then get told I needthatmuch money.

[Jim1967 3,569]

Hi there,, I have Cigna and they covered my surgery as well as my fill adjustments. What Cigna covers may depend on what tier coverage your company purchased. I recommend you call Cigna and ask for the written policy on weight loss surgery. Someone on this board posted a week or so ago that Cigna changed the requirement on a supervised diet. It used to be 6 month monitored which is what I did but someone on here said they only had to do 3 month.

Here is a link to Cigna's policy on wls surgery that I was given. Again it sounds like it changed and this doc was only credible up until 5/15/12. Remember this is your insurance and you are a customer. Call them and ask them for information in writing and they will provide it.

Good Luck, Jim

sorry forgot the link: http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

Edited June 2, 2012 by Jim1967

[Jim1967 3,569]

Oh and I had a max out of pocket for the year of $1500 which I had already met prior to surgery so everything was covered with no cost to me. $5K for the surgeon, $1500.00 for Anesthesia and $14K for the hospital stay. I stayed overnight. Thank god for insurance!!

[lrhodes46 55]

Thanks. I will call them. I dont know if they told the patient coordinator that price because they assumed the doctor was out of network. I'm going through true results and one of their doctors is in network and the other two are not. Thanks for the link!