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Exclusion for obesity surgery excludes Lap Band? CIGNA

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Started by SuzieInTexas, Oct 11, 2011 12:54 PM
8 replies to this topic
8 replies to this topic

    SuzieInTexas

    Novice

  • Posts: 11
  • Joined: Oct 2011
  • Gender: Female
  • Location: TEXAS
  • Surgery: LAP-BAND
  • Surgeon: Dexter Turnquest
  • Surgery Date: Dec 2011
  • Height: 5 feet 2 inches
  • Starting Weight: 263
  • Weight Lost: 78
  • Current Weight: 185
  • Goal Weight: 140
  • BMI: 33.8
  • My Blogs
Posted October 11, 2011 - 12:54 PM

#1
The patient advocate at True Results called and told me that my insurance, CIGNA, will cover my Lap Band, and she gave me an out of pocket price, CIGNA requirements, etc. However, when I look up my insurance summary it says obesity surgery is excluded. Could it be that CIGNA can exclude the Lap Band procedure from an obesity surgery exclusion? Or is someone pulling my leg?


    Corrigan

    Bariatric Evangelist

  • Posts: 757
  • Joined: Jul 2011
  • Gender: Male
  • Location: CA
  • Surgery: LAP-BAND
  • Surgeon: Miguel Burch
  • Surgery Date: Sep 2011
  • Height: 6 feet 1 inches
  • Starting Weight: 300
  • Weight Lost: 80
  • Current Weight: 220
  • Goal Weight: 200
  • BMI: 29
Posted October 11, 2011 - 1:23 PM

#2
I doubt that True Results will be paying for your surgery. Many insurance companies have a weight loss exception, however most
will pay for weight related illnesses such as diabetes, sleep apnea, etc.(comorbidities). If you have such illnesses, your chances
of getting WLS are much better. Best of luck.


    SuzieInTexas

    Novice

  • Posts: 11
  • Joined: Oct 2011
  • Gender: Female
  • Location: TEXAS
  • Surgery: LAP-BAND
  • Surgeon: Dexter Turnquest
  • Surgery Date: Dec 2011
  • Height: 5 feet 2 inches
  • Starting Weight: 263
  • Weight Lost: 78
  • Current Weight: 185
  • Goal Weight: 140
  • BMI: 33.8
  • My Blogs
Posted October 11, 2011 - 2:08 PM

#3

I doubt that True Results will be paying for your surgery. Many insurance companies have a weight loss exception, however most
will pay for weight related illnesses such as diabetes, sleep apnea, etc.(comorbidities). If you have such illnesses, your chances
of getting WLS are much better. Best of luck.


Thanks Corrigan. I'm definitely worried about it. I don't have any major comorbites, but I am at 48+ bmi. I guess my fear is getting through the 6 months then getting told that there really was an exclusion. I checked my insurance website and did not see anything on a pre-cert or inquiry.

This will be difficult enough without having to be told, "hey sorry, but we made a mistake".


    Dulci

    Junior Guru

  • Posts: 338
  • Joined: Jul 2011
  • Gender: Female
  • Location: FL
  • Surgery: LAP-BAND
  • Surgeon: Samuel Szomstein
  • Surgery Date: Oct 2011
  • Height: 5 feet 3 inches
  • Starting Weight: 220
  • Weight Lost: 73
  • Current Weight: 147
  • Goal Weight: 140
  • BMI: 26
  • My Blogs
Posted October 11, 2011 - 10:06 PM

#4
Call the customer service number on the back of your card, give them your member number and ask if YOUR policy will cover WLS. Most insurance companies do offer coverage for WLS, but many employers choose to exclude WLS to keep costs down.

The only way you can be 100% if YOUR policy includes WLS is check the actual policy or to call the company and check what your specific policy covers.

Good Luck.


    CIGNAQuestions

    Intermediate Member

  • Posts: 25
  • Joined: Apr 2010
  • Location: PENNSYLVANIA
  • Surgery: LAP-BAND
Posted October 12, 2011 - 5:20 AM

#5

The patient advocate at True Results called and told me that my insurance, CIGNA, will cover my Lap Band, and she gave me an out of pocket price, CIGNA requirements, etc. However, when I look up my insurance summary it says obesity surgery is excluded. Could it be that CIGNA can exclude the Lap Band procedure from an obesity surgery exclusion? Or is someone pulling my leg?




    SuzieInTexas

    Novice

  • Posts: 11
  • Joined: Oct 2011
  • Gender: Female
  • Location: TEXAS
  • Surgery: LAP-BAND
  • Surgeon: Dexter Turnquest
  • Surgery Date: Dec 2011
  • Height: 5 feet 2 inches
  • Starting Weight: 263
  • Weight Lost: 78
  • Current Weight: 185
  • Goal Weight: 140
  • BMI: 33.8
  • My Blogs
Posted October 12, 2011 - 7:54 PM

#6
Well, I'm toast. Posted Image I called the insurance myself and its a no go. The exclusion applies, so unless I finance it myself I can't do it. Post divorce, my credit sucks too. I have two options: 1. My employer insurance dumps the exclusion for 2012 (open enrollment starts Nov 1st, so I'll know soon) or 2. borrow from my 401k. I was so excited and so pumped to do this. The let down is painful, and I'm practically in tears.

So the question remains unanswered: why would True Results say I'm covered and even give me an out of pocket cost? Posted Image


    CIGNAQuestions

    Intermediate Member

  • Posts: 25
  • Joined: Apr 2010
  • Location: PENNSYLVANIA
  • Surgery: LAP-BAND
Posted October 13, 2011 - 10:06 AM

#7
[quote name='SuzieInTexas' timestamp='1318355654' post='1673005']
The patient advocate at True Results called and told me that my insurance, CIGNA, will cover my Lap Band, and she gave me an out of pocket price, CIGNA requirements, etc. However, when I look up my insurance summary it says obesity surgery is excluded. Could it be that CIGNA can exclude the Lap Band procedure from an obesity surgery exclusion? Or is someone pulling my leg?


Your benefits are really based off of your actual policy with us. I could assist you with this if you send me your contact info to SCR_isolve@cigna.com.


    katwomantexas

    Expert Member

  • Posts: 107
  • Joined: Apr 2011
  • Gender: Female
  • Location: TEXAS
  • Surgery: LAP-BAND
Posted October 14, 2011 - 6:30 PM

#8
Hello Suzi, I live in Texas and have Cigna insurance. I also used True Results in Austin. Mine was all covered except for deductibles and my portion.

Kat

The patient advocate at True Results called and told me that my insurance, CIGNA, will cover my Lap Band, and she gave me an out of pocket price, CIGNA requirements, etc. However, when I look up my insurance summary it says obesity surgery is excluded. Could it be that CIGNA can exclude the Lap Band procedure from an obesity surgery exclusion? Or is someone pulling my leg?




    katiebug3608

    Newbie

  • Posts: 6
  • Joined: Oct 2011
  • Gender: Female
  • Location: LA
  • Surgery: LAP-BAND
  • Surgeon: Ata Ahmad
  • Height: 5 feet 4 inches
  • Starting Weight: 213
  • Weight Lost: 0
  • Current Weight: 213
  • Goal Weight: 130
  • BMI: 36.6
Posted October 20, 2011 - 3:14 PM

#9
Hey under my insurance (i have cigna) if i look online it says that it excludes obesity surgery BUT i kept looking and it says that it covers lap band! so i call the customer service line and they told me no at first BUT i told them what i found and they said that lap band is covered!! and it's covered 85%!! so that's huge!!! dont get discourage!! but when you logg into mycigna.com and then find the "find" button type in lap band and it will go right to it! hope this helps!

oh and they said that it's only covered if it's a medical requirement and if you meet all the criteria.


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