GAH! Help me decipher this so I can sleep tonight

[petergriffin 0]

:help::eek:

I just got an updated insurance packet from my employer yesterday. Tonight I finally sat down to check it out. So I'm reading all about what it covers (I have Cigna OAP). On one of the first pages it reads:

"Outpatient Facility Services includes:

Operating Room, Recovery Room, Procedure Room and Diagnostic/Therapeutic Lab

Physician and Outpatient Professional Services"

This is still listed as 20% which is what its always been and what I always considered what I'd be paying for getting banded.

But then I go to the back where they list exclusions and this one is on there:

"Medical and surgical services, initial and repeat, intended for the treatment or control of obesity, including clinically severe (morbid) obesity, including: medical and surgical services to alter appearances or physical changes that are the result of any surgery performed for the management of obesity or clinically severe (morbid) obesity; and weight loss programs or treatments, whether prescribed or recommended by a physician or under medical supervision."

Also at the end it lists a whole bunch of stuff not covered however lap banding isn't in there (where it looks like it would probably fit if not covered). Of course its Sunday night and Cigna is closed and for some reason mycigna.com has been down for me for several weeks. Can anybody help me out with this?

[Wheetsin 714]

"Medical and surgical services, initial and repeat, intended for the treatment or control of obesity, including clinically severe (morbid) obesity, including: medical and surgical services to alter appearances or physical changes that are the result of any surgery performed for the management of obesity or clinically severe (morbid) obesity; and weight loss programs or treatments, whether prescribed or recommended by a physician or under medical supervision."

It reads to me that surgical treatments for obesity, post-op aesthetic treatments such as plastic surgery, and treatment programs such as Weight Watchers or Jenny Craig are excluded from your policy.

Usually specific procedures aren't listed as exclusions. So, for example, they will say something like "surgical treatment of morbid obesity" instead of listing each and every procedure out there.

They would never list "lap-band" so don't bother looking for it. Lap-band is a brand name, not a generic term. "Adjustable gastric banding" is usually what it's referred to as, but if surgical treatment of morbid obesity is excluded, the band would normally be part of that.

There is a procedure code for adjustable gastric banding posted here. I don't remember what it is, but run a search. Then just call and ask if that's covered. If you can't find the code, call and ask about adjustable gastric banding as a surgical treatment for morbid obesity.

[petergriffin 0]

That's what I thought as well but seeing anything under exclusions about this really scared me. I do remember seeing the code somewhere on here, but I am def. calling in the morning. Thanks for the help!