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Exclusion for obesity surgery excludes Lap Band? CIGNA



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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?

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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.

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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".

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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.

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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?

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Well, I'm toast. sad.gif 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? angry.gif

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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.

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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?

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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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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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      https://alluniqueguide.com/java-burn-coffee-reviews/
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