Attended my consult

[mjm1812 3]

Attended my consult with NYU today!

Everything was great! Everyone was great! Dr. Bedrosian was great! (Minus the # that popped up on the scale when I was weighed!)

My surgical coordinator provided me with a checklist to complete in the months leading up to surgery to ensure I get approved by my insurance. She also provided me with a list of questions to ask my insurance (kind of odd - but she stated she would need me to do this because Cigna makes her wait too long).

I call Cigna (through my husband’s employer) and the rep tells me she cannot provide me with the exclusions for bariatric surgery or weight loss management as the provider’s office will need to do this but there is a benefit through my plan that requires precert, which the clinic will need to contact Cigna or check online through their provider portal and provide the details to inquire on the exclusions and what marks need to be met in order to get authorized. I feel like that call just ruined my high of hopes after today’s visit!

But my word of the day is hope

Learning about my “potential” coverage, scheduling the appointment, getting the support from my PCP and meeting the NYU weight loss team has provided me with a sense of hope.

I finally said it out loud to my husband that I’m not doing this just to be skinny. I’m doing this to get healthy and one day be an active mom for our future family and not have to be in pain or uncomfortable.

Let’s hope that the surgical coordinator has a better shot at obtaining information from Cigna

[Sosewsue61 3,185]

If you use the email in the online portal for the insurance they will answer all your questions, such as - am I required to submit an exercise regimen, am I required to lose weight prior to surgery or am I required not to gain weight, am I required to have a sleep study, EDG, stress test, have co-morbities, a certain bmi, can I be denied for any of the above reasons, do I have to attend # of counseling or monthly support meetings, etc. Ask for how long after meeting requirements and submission do they make a determination. And after approval how long do you have to schedule surgery - some give you 6 months once approved. Ask them to attach the specific policy pages that refer to bariatric surgery qualifications to the email. Ask for the phone number of the department that addresses these issues - surgery intake specialist, etc.

The person you spoke to has no authority to answer these because that person has no decision making power, there is a specific team that does this.

Don't worry. The ins coordinator at the surgeon's office deals with difficult ins companies all the time and they know how to submit the correct paperwork. But keep on top of the ins agency for answers, keep emailing the specific team.

[mjm1812 3]

If you use the email in the online portal for the insurance they will answer all your questions, such as - am I required to submit an exercise regimen, am I required to lose weight prior to surgery or am I required not to gain weight, am I required to have a sleep study, EDG, stress test, have co-morbities, a certain bmi, can I be denied for any of the above reasons, do I have to attend # of counseling or monthly support meetings, etc. Ask for how long after meeting requirements and submission do they make a determination. And after approval how long do you have to schedule surgery - some give you 6 months once approved. Ask them to attach the specific policy pages that refer to bariatric surgery qualifications to the email. Ask for the phone number of the department that addresses these issues - surgery intake specialist, etc.
The person you spoke to has no authority to answer these because that person has no decision making power, there is a specific team that does this.
Don't worry. The ins coordinator at the surgeon's office deals with difficult ins companies all the time and they know how to submit the correct paperwork. But keep on top of the ins agency for answers, keep emailing the specific team.

Omg thank you. I didn’t even think of that! I will try that and hopefully I’ll get some answers.

[blakescat 10]

I am so glad everything went well with Dr. Bedrosian. Her Coordinator was really great with me and had the process down. Maybe she just doesn't get Cigna often? Despite that while you get everything figured out enjoy the ride and get your list done. Its taking longer then I thought it would, but glad now I have the time. [emoji4]

Sent from my LG-H901 using BariatricPal mobile app

[mjm1812 3]

I am so glad everything went well with Dr. Bedrosian. Her Coordinator was really great with me and had the process down. Maybe she just doesn't get Cigna often? Despite that while you get everything figured out enjoy the ride and get your list done. Its taking longer then I thought it would, but glad now I have the time. [emoji4]

Sent from my LG-H901 using BariatricPal mobile app

Yes! Her coordinator was wonderful. It just so happens that this Cigna plan is a little different than standard Cigna in terms of obtaining information as they don’t even offer email/online support other than calling into their “concierge line” for his employer but I emailed Nilsa on Monday and am waiting to hear back from her. Hopefully she has better luck than I do.

I have a few items to complete in December like the TSH lab test and the psych evaluation so I’ll probably schedule them on the same day as my December follow up. I want to complete them now! Lol

Do you have a scheduled surgery date or an idea when it may take place?

[blakescat 10]

Yes! Her coordinator was wonderful. It just so happens that this Cigna plan is a little different than standard Cigna in terms of obtaining information as they don’t even offer email/online support other than calling into their “concierge line” for his employer but I emailed Nilsa on Monday and am waiting to hear back from her. Hopefully she has better luck than I do.

I have a few items to complete in December like the TSH lab test and the psych evaluation so I’ll probably schedule them on the same day as my December follow up. I want to complete them now! Lol

Do you have a scheduled surgery date or an idea when it may take place?

No surgery date yet. She will be back from Maternity Leave then. I will keep you posted.

Sent from my LG-H901 using BariatricPal mobile app

[Sosewsue61 3,185]

https://my.cigna.com/web/public/guest

Of course your husband's company negotiated the type of coverage for the insurance contract.

What state are you in?

[mjm1812 3]

https://my.cigna.com/web/public/guest

Of course your husband's company negotiated the type of coverage for the insurance contract.

What state are you in?

Certainly! The coverage is great don’t get me wrong, just the ability to obtain information is much more complex than any other insurance I’ve had. I’ve come across other medical carriers being as complex or worse trying to verify coverage on the provider side in my career field but this is my first time experience this as a member with my own insurance [emoji853]

I’m in New Jersey

[mjm1812 3]

https://my.cigna.com/web/public/guest
Of course your husband's company negotiated the type of coverage for the insurance contract.
What state are you in?

Yeah the crappy part is that I can log in and do many things like find a provider, get an estimate on costs, check claims status and go to “understanding my coverage” and it’ll confirm that Auth is required for bariatric surgery. But it won’t provide me with a certificate of coverage or any PDF with exclusions like I’ve seen with UHC for example.

[mjm1812 3]

I’ve been emailing with my surgical coordinator. She confirmed with Cigna that I do have bariatric benefits and qualify for surgery due to my BMI and there are no exclusions..... I need to have 3 more visits - November, December and January (this will most likely be surgical planning for February)... YAY!