Cigna & WLS excluded

drpeperlvr · September 14, 2007

I have Cigna insurance in Arizona and they say that WLS is excluded in our policy. Has anyone fought them and won? Would it be worth hiring a lawyer? Please someone help me!!

Steven :help:

WASaBubbleButt · September 14, 2007

If it is excluded then you will not be able to get them to pay. Weight loss surgery is an extra premium and if it is not paid, they will not cover it.

It's like having dental insurance an wanting your dental insurance to cover a hysterectomy. It's just not going to work. You have to purchase the WLS premium and if your insurance is through your employer they call the shots on what pieces of coverage they are willing to purchase.

drpeperlvr · September 14, 2007

Thanks for responding!! So can I pay the extra premium?? My HR department will not give me straight answers. OR can I purchase supplimental insurance to cover it? I am just so afraid that if I self pay and then have complications that my current (employer paid) insurance won't cover the complications.

WASaBubbleButt · September 14, 2007

Thanks for responding!! So can I pay the extra premium?? My HR department will not give me straight answers. OR can I purchase supplimental insurance to cover it? I am just so afraid that if I self pay and then have complications that my current (employer paid) insurance won't cover the complications.

No, you can't buy a portion of your employer's policy. Your employer would have to buy it and offer it to every employee. From what I understand it is quite expensive and that is likely why they exclude it from the policy. If they don't want to pay for the premiums, they don't have to. An employee can't just purchase this portion of a policy, that isn't how it works. You have no WLS coverage. You are looking at self pay at this point.

If you were to get a supplemental insurance policy they would likely exclude WLS because it is a pre-existing condition. They try to avoid people buying a policy just for a specific procedure. As you can imagine, they would be taking losses on that with each insured person and no business can do that.

As for complications, the three main complicatons that would require surgical intervention are erosion, slips, and infection. Erosion and infection would likely be covered under your policy if it was an emergency situation. Slips can be fixed 80% of the time with an unfill. 20% of the time it requires surgical intervention. This is when you look for the very best doc around with great erosion and infection stats. Usually (not always) slips are the patient's fault. There is one doc that has had 1-2 erosions in 1600 bands. Then there is another doc that has 3-4% erosion stats. Quite a significant difference.

drpeperlvr · September 14, 2007

Thanks for your responses... Not exactly what I was wanting to hear.. lol So I guess I will just self pay and move on. Not dwell on what "might" happen. I would love to talk to you about your Mexico banding, can you send me a private message. Thanks so much!

WASaBubbleButt · September 14, 2007

Thanks for your responses... Not exactly what I was wanting to hear.. lol So I guess I will just self pay and move on. Not dwell on what "might" happen. I would love to talk to you about your Mexico banding, can you send me a private message. Thanks so much!

Sure. I will send you a list of things you need to look for in a bariatric surgeon and going to Mexico. You have a lot of work ahead of you in research. You should know everything there is to know about the band and everything there is to know about the doc you choose. You have a ton of reading ahead of you.

Sorry I can't give you better options for insurance. The WLS portion of the policy is a good place employers feel to save money. I understand it is a bit expensive.

Are you absolutely positive that you don't have WLS coverage? I would look it up in the policy for yourself and see where it is excluded. Just make extra sure. HR isn't always right and when you call the insurance company they don't always give out correct information either.