My employer will be changing from our current insurance, oxford, to a new insurance company, cigna. What the hell am I gonna do! I had no problems with oxford covering the lap band, but cigna is saying that they do not cover the surgery! I cannot have my surgery done before my insurance changes because I still have a few more pre op appointments. It is not listed as an exclusion with cigna, but they do have an exclusion for weight loss programs and the rep was saying that this would be classified as a weight loss program!!!:eek: That does not make any sense! What should I do guys! This is the worst timing ever! Please HELP!!!

I have Cigna, and they paid for 90% of my surgery after my deductibles and max OoP was met for the year (cost me about $1500), however I do know that them covering it is an option for your employer to purchase that kind of coverage and luckily mine did that. Right now though I may be needing revision surgery (possible slip) and if I am reading my coverage correctly I lost too much weight for them to fix me :frown:

You might consider contacting Obesity Law. They don't charge unless they get results. I think the attorney you want to talk to is Walter Lindstrom.

Best of luck to you.

Is any weight loss surgery covered?

They could be an alternative to lap-band.

Read your policy carefully. In mine, "weight loss programs" means stuff like Weight Watchers, for which there is NO reimbursement. However, banding is a surgery, and the policy spells out the criteria that must be met in order to qualify.

It will all be there, in black and white--no need to panic yet. Just get a copy of the policy. Reps sometimes really don't know about specific things; they're the Big Picture people.

Guys thank you so much for your help! My hr department just got back to me and said that it is a covered benefit!:frown: I was so excited! I'm still wondering why cigna tried to say that it was not covered? I'm also concered that I might have to start my six month diet over. Hopefully not, but I'm still going to try and get most of my pre op apps done before my insurance changes.:mad2: Thanks again guys!

Cigna is not a good insurance company! This will be the first of many problems for you, sad to say! They are just horrible and they play games.....its horrible!

So sorry to hear what you are going through, I hope you can get it worked out to do it this year.

I don't understand the American health care system! Here in Australia you choose the private health care policy that suits you best and pay your premiums or you rely on Medicare (public health system) and put your name on waiting lists for elective surgery and wait, wait, wait. Mind you i have private health and waited 6 weeks to have surgery and paid a $3000 co payment on top of my benefits and my sister went public and waited 2 years and paid nothing.

Good luck with getting your surgery covered it must be stressful for you.

Guys thank you so much for your help! My hr department just got back to me and said that it is a covered benefit!:eek: I was so excited! I'm still wondering why cigna tried to say that it was not covered? I'm also concered that I might have to start my six month diet over. Hopefully not, but I'm still going to try and get most of my pre op apps done before my insurance changes.:tt2: Thanks again guys!:thumbup:

So glad to hear everything has worked out for you! As for your 6 month diet, you should not have to start again as long as you have your documentation. It should be about whether or not you have been on a 6 month supervised diet not whether you have been on their 6 month diet. That said, when I was choosing a doc on my plan (BC/BS, uggghhh) one of the covered providers was Cedars Sinai and they have their own "special" program. So after seeing 3 docs that turned out not to be on my insurance (long story), I had already started my 6 months with my therapist and I was not about to start again with Cedars; so I went to a different doc.

Everything will work out fine for you, the best is yet to come!

~F

Hi, there! I, too am fighting with Cigna. My husband is a nurse at a local hospital chain here in Tucson, and Cigna policy specifically states that lapband and ANY type of weight loss program is NOT covered. They just denied me, even though I have met ALL the requirements, done all the preop "hoop jumping". To add insult to injury, they also state that they have a NO APPEAL PROCESS. I don't like to take No for an answer, so I am doing my homework on the cost for overweight healthcare workers just to add to my letter to see if that might shake them up. Doubt it, but everything is worth a try. Good luck to you. :eek:

A similar issue happened to me. The difference was, my benefits were changing to no longer cover surgery. I was cutting it close by a month.

I was able to work with the insurance and doctor and get approved earlier than anticipated. I was one appointment short of that required by insurance. I called my insurance over and over and over to finally talk with one person that said "yea just go ahead and submit early"..........Keep on top of it! Don't give up.........it's a life event that's worth fighting for!

Hi, there! I, too am fighting with Cigna. My husband is a nurse at a local hospital chain here in Tucson, and Cigna policy specifically states that LAP-BAND® and ANY type of weight loss program is NOT covered. They just denied me, even though I have met ALL the requirements, done all the preop "hoop jumping". To add insult to injury, they also state that they have a NO APPEAL PROCESS. I don't like to take No for an answer, so I am doing my homework on the cost for overweight healthcare workers just to add to my letter to see if that might shake them up. Doubt it, but everything is worth a try. Good luck to you. :eek:

Contact the insurance commissioner of your state. I'm pretty sure that insurance companies are required to have an appeals process. Of course, they will tell you anything to get rid of you because it works with so many people. So, don't give up. That's what they're counting on.

:lol:Cigna (DOES) cover Lap-Band surgery! My cousin has Cigna & also two others friends of mine that had the Lap-Band surgery done have Cigna..... The difference between Oxford & Cigna is that Cigna requires a 6month pre-op diet before they will even consider weight loss surgery. I have Oxford (thank God) & they DO NOT require a pre-op diet... Why don't you try to get all of your pre-op testing done & start a diet as if you've already had the Lap-Band done; that's what I did.... I found out on 10/13/10 that I had to lose pre-op weight (not per Oxford-but per Surgeon)... So the next day I got my Protein shake powder mix, I cut out bread-rice-Pasta & sodas & on my way I was... I have a shake for Breakfast, a shake for lunch, & a small portioned size plate of food for dinner that consist of protein & veggies. As of today 11/05/10 I have lost 13 pounds & the surgeon only asked for 12 pounds to be lost..I also include walking & that really helped me out. I have done all of my pre-op testing with the exception of meeting with the psychiatrist & I do that on 11/11/10. I didn't wait for anyone to tell me to do anything. I just found out what pre-op appts were necessary & did them. I did that so that I can get banded before the new year..... It's not too late for you to put your best foot forward & get those appts in before your coverage with Oxford ends. Most likely it will end at the end of 2010 right?? You can do it. My will power kicked in & I took control... Good luck on your journey....

My employer will be changing from our current insurance, oxford, to a new insurance company, cigna. What the hell am I gonna do! I had no problems with oxford covering the LAP-BAND®, but cigna is saying that they do not cover the surgery! I cannot have my surgery done before my insurance changes because I still have a few more pre op appointments. It is not listed as an exclusion with cigna, but they do have an exclusion for weight loss programs and the rep was saying that this would be classified as a weight loss program!!!:thumbup: That does not make any sense! What should I do guys! This is the worst timing ever! Please HELP!!!:eek: