An actual POSITIVE insurance story

[elforman 234]

I've been meaning to share this for a while. For a long time I'd been under the impression that bariatric surgery was covered by my health plan through work. Someone else in the company had it and said "Yeah, CIGNA covered it for me." Well, what I didn't know was he had the CIGNA *** plan and I was on the PPO. And when I compared the exemptions between the two plans, the only difference was that the *** covered weight loss programs and bariatric surgery while the PPO didn't because it was classified as "cosmetic." Switching to the *** plan was not an option for me or my family.

So I went to our HR department and explained the situation. They contacted our insurance broker and the got bariatric coverage added to the PPO plan effective 1/1/18. My appointment with the doctor is 1/3/18 at which point I'll kick off the whole process.

But the point is: If your insurance doesn't cover what you need, just ask about it. More and more companies are covering weight loss surgery when there is a demonstrated need. I actually work for a health plan and I know that the numbers show it's much more cost effective to help the member lose the weight than to pay for all of the medical complications that will arise if obesity is left untreated.

Here's the letter I sent to our HR director that got the ball rolling. Feel free to edit it and send to your own HR directors if you think it will help:

Quote

I’d to make you aware of an issue I have with the CIGNA PPO plan. My concern is that the plan treats obesity as a cosmetic issue instead of a medical issue and therefore offers no coverage for weight loss services or surgery even if deemed medically necessary. The CIGNA *** plan, however, does offer such coverage. Unfortunately, switching to the *** plan or Kaiser is not an option for me and my family.

I have no problem disclosing that my doctor has recommended weight loss surgery for me. I have had several injuries which combined with my arthritic conditions make it practically impossible for me to perform any aerobic exercise. Trying to lose weight without accompanying exercise has proven extremely difficult and has only triggered further depression.

It is distressing that the PPO plan offers coverage for drug and alcohol abuse but does not recognize obesity as a medical condition. Further, many insurance plans recognize that the cost of treating obesity is far less in the long run than treating the conditions that arise from leaving it untreated. Obesity is anything but a cosmetic issue.

I know all I can do is present my case and hope for the best. While I’d otherwise be happy to switch plans to get the services I need, it does not seem fair that I should have to. I’d be happy to discuss this with you at your convenience.

[elforman 234]

This is interesting...

Looking back at my post I can see that the three letter acronym for Health Maintenance Organization was censored out. I know many people consider it to be a four-letter word, but really, replacing it with asterisks?

[confusedturtle3 246]

I've been meaning to share this for a while. For a long time I'd been under the impression that bariatric surgery was covered by my health plan through work. Someone else in the company had it and said "Yeah, CIGNA covered it for me." Well, what I didn't know was he had the CIGNA *** plan and I was on the PPO. And when I compared the exemptions between the two plans, the only difference was that the *** covered weight loss programs and bariatric surgery while the PPO didn't because it was classified as "cosmetic." Switching to the *** plan was not an option for me or my family.
So I went to our HR department and explained the situation. They contacted our insurance broker and the got bariatric coverage added to the PPO plan effective 1/1/18. My appointment with the doctor is 1/3/18 at which point I'll kick off the whole process.
But the point is: If your insurance doesn't cover what you need, just ask about it. More and more companies are covering weight loss surgery when there is a demonstrated need. I actually work for a health plan and I know that the numbers show it's much more cost effective to help the member lose the weight than to pay for all of the medical complications that will arise if obesity is left untreated.
Here's the letter I sent to our HR director that got the ball rolling. Feel free to edit it and send to your own HR directors if you think it will help:

I’d to make you aware of an issue I have with the CIGNA PPO plan. My concern is that the plan treats obesity as a cosmetic issue instead of a medical issue and therefore offers no coverage for weight loss services or surgery even if deemed medically necessary. The CIGNA *** plan, however, does offer such coverage. Unfortunately, switching to the *** plan or Kaiser is not an option for me and my family.



I have no problem disclosing that my doctor has recommended weight loss surgery for me. I have had several injuries which combined with my arthritic conditions make it practically impossible for me to perform any aerobic exercise. Trying to lose weight without accompanying exercise has proven extremely difficult and has only triggered further depression.


It is distressing that the PPO plan offers coverage for drug and alcohol abuse but does not recognize obesity as a medical condition. Further, many insurance plans recognize that the cost of treating obesity is far less in the long run than treating the conditions that arise from leaving it untreated. Obesity is anything but a cosmetic issue.
I know all I can do is present my case and hope for the best. While I’d otherwise be happy to switch plans to get the services I need, it does not seem fair that I should have to. I’d be happy to discuss this with you at your convenience.

That is great that they switched that up for you, awesome job advocating for that. Will they allow you start seeing the nutritionist sooner than Jan so you will be a month closer to surgery by the time the change takes place? That is strange that the letters were replaced with asterisks, how weird lol.


Have a great day!
Amanda [emoji16]
HW 248 CW 241 Surgery Date: pending 11/21/2017. Goal weight 150’ish [emoji23]

[elforman 234]

No, if I see the nutritionist before Jan. 1 I'd have to pay for it out of my own pocket. The only reason they paid for my initial consult with the bariatric surgeon is because he coded the visit as severe GERD as the primary complaint. But I don't mind waiting until the start of the year as I've got enough stuff going on at the moment. And while I don't care one iota about the holidays, I do have a tradition of cooking up a nice, expensive feast for the family on New Years, so that will be my last hurrah.

[ProudGrammy 8,322]

21 hours ago, elforman said:

they got bariatric coverage added to the PPO plan

@elforman

speaking up for yourself

being proactive

challenging the ins. company/rules.

girlfriend, you are ACES!!

good luck next year

Kathy

[elforman 234]

Thank you. Assertiveness has never been an issue for me. Plus, as I demonstrated, I sent in prepared.

However, I will point out that I am male. I'll try to add more testosterone to my future posts to avoid any confusion. Or maybe I'll just leave the toilet seat up...

Sent from my SM-G930T using BariatricPal mobile app