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Troubling News From My Insurance Company

Jim1967

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So I was one of the lucky ones who was able to get their insurance company to cover the banding procedure. In fact I paid nothing at all out of pocket because I had already reached my max year out of pocket of $1500 due to an earlier surgery I had in March.

 

Yesterday, I got home and in the mail I found a lovely letter from my primary care doctor who informed me as of August 1st I need to either find a new PCP or get a different insurance carrier. Cigna has decided to drop its affiliation with Lowell General Hospital. Cigna requires that PCP be on staff at a hospital they are affiliated with which was that hospital. So I said, great now I need to find a new primary care doctor after 10 years of being with the same one.

 

Now it gets even better as reality sets in and I realize duh, I was banded a Lowell General and my Surgeon is on Staff there. His entire practice is tied to that hospital. So now adjustments, routine visits and god forbid I need surgery again it is all going to be out of network!!

 

As a lot of us know switching Surgeons when it comes to the band is not always an easy task. I am just over 2 months of being in the banded ranks and have only had two fills and I know I need more. I cannot help but be discouraged here but the only bright side I can see is at least I am banded and this didn't happen a week before surgery......

 

I have contacted my HR dept this morning at work to see if they can look into this a little further..



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Oh no!! Maybe I'm being overly optimistic, but it's possible that they will still cover your surgeon. Is he on staff at any other hospitals? Because if so, then hopefully it's one your insurance will cover so you won't have to switch surgeons.

Good luck and let us know what happens!

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Good point!! Thanks for mentioning that. I know he is affiliated with another hospital but I cannot remember which. I have to check that.

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jim, i am sorry to hear that. i am thinking also, you dr may be associate with other hospitals also just as mis said. stay positive. i believe good things happen to good people and you are a good person.

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Just got this response back from my HR Dept.

We have been notified of this issue. Fortunately, our employees are not being affected by this change. Even though we are through Cigna, we are part of the Tuft’s platform which means that coverage will remain the same and it will continue to be accepted at your primary care physician’s office and Lowell General. Only people who carry Cigna insurance on Cigna’s platform are being affected. This has been confirmed by our rep at Cigna. Hopefully this eases your mind a little bit. Please let me know if you have any additional questions or concerns.

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Call your surgeon and call your insurance carrier. I work for a large hospital (In the billing dept) and there are times when, based on your employers policy, that your insurance will still be accepted. It all has to do with the contracting network. The insurance itself can remain the same, but the contracting network can change. Work closely with your insurance company, employer, and provider to make sure you have everything in writing that they are still going to pay contracted rates.

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Hey Jim,

Call your insurance carrier and have them help you find a new doctor. That's what you pay them for after all.

We had gotten a letter that our old insurance was going to stop covering our local hospital.... i was so scarred, but they worked something out and signed back on... but i lost my job and got different insur that doesn't cover WLS at all so now all my fills are out of pocket.

Hope everything works out for you.

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Thanks all. I am all set. My HR dept straightened out. This is what my HR Dept said:

We have been notified of this issue. Fortunately, our employees are not being affected by this change. Even though we are through Cigna, we are part of the Tuft’s platform which means that coverage will remain the same and it will continue to be accepted at your primary care physician’s office and Lowell General. Only people who carry Cigna insurance on Cigna’s platform are being affected. This has been confirmed by our rep at Cigna. Hopefully this eases your mind a little bit. Please let me know if you have any additional questions or concerns.

I have since called my PCP and I am all set. No issues.

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