Hi I'm new and starting my process/ insurance question's

[AllisonK1986 68]

Hi my name is Allison and I live in Summerville, Sc right outside of Charleston. I have great west insurance through Cigna PPO. They say they cover it 80/20 only if it's proven that I am morbidly obese which I am. I'm 280 with a bmi of 45. My husband is worried he will get laid off and I'm wanting to get the surgery asap, but it's a 3-4 month process. My other option is at MUSC, but their have been bad reviews. They said that I could have it within 1 month n a half. But the office I'm going to now has told me they have had to fix several mistakes made by those surgeons.

Has anyone had experience with my insurance and I'm

Very worried.

[Sharon1964 2,530]

What exactly are you worried about? You've talked to the insurance company, right? Document the date, time, name of the person you spoke to and what they said. If you haven't actually called them, then do that. Ask for all of their requirements for gastric surgery, and ask them if they cover roux-en-y, vertical sleeve gastrectomy, and lap band (so you know what your options are).

Keep written details of every interaction with the insurance company.

[ShrinkingPeach 1,291]

In order for your surgery to be covered at any rate your date of surgery has to be while you are covered. If you start the process now, the sooner the better, maybe you can get it all in before a lay-off can happen. If not then your husband can elect to have COBRA until you get the surgery done.

That is the ONLY way it will be covered, notes won't help you. Get the process rolling and good luck!!

[AllisonK1986 68]

Thanks Shrinking Peach!

[Sharon1964 2,530]

Keeping notes has helped several people get their surgery covered. In their cases, they were told on numerous occasions that gastric surgery was covered, but then it was denied as "not a covered benefit" when it came time to get the authorization. If you can show the insurance company that their mistakes caused you to go through the pre-op process, you have a very good chance of getting them to cover it, even if it's not covered on your plan.

As you said, though, you do have to have active insurance on the day of your surgery in order for it to be covered.

[Djmohr 6,965]

I actually lived through this exact situation, I was 4 months into the 6 month process and was laid off from work. The only way to get it covered was to take the cobra. I did and everything was covered as if my insurance was exactly the same.

Don't kept the Kay off worry you. Get on the phone today with your insurance company because they are who controls the process. Tell them to send you a list of their requirements. Most even control who they will authorize for your surgery. For example one of the requirements for Medica was that I used one of their approved centers of excellence. There were several other requirements and you need to know exactly what those are.

Also you have to be on top of every little thing to ensure you get through the process as quickly as possible. That means follow up with your doctors office and get copies of all your nutritionist visits along the way.

Good luck, your situation can definately be ok if you stay on top of it.

[AllisonK1986 68]

Thanks so far insurance is just saying letter of medical necessity.