Is this crazy or what?

jennypoo1 · 10-24-2007, 09:19 PM

I am having issues trying to figure out if my inusurance will cover my surgery. When I call Cigna they tell me any weight loss surgery is excluded in my policy. When I contact my HR dept at work they say their are no exclusions on our policies! I am so frustrated getting 2 different answers.

And of course everyone says their answer is right. I dont know what to do. Any suggestion?:help:

babs0101 · 10-25-2007, 01:28 PM

Have your HR Dept. call your insurance while you are sitting right there and ask the question.

jennypoo1 · 10-26-2007, 12:20 AM

Thanks for the advise, but I am traveling therapist and my company is based in Florida, so I have never even seen these ppl. I transact all my business through the phone and mail. Thanks though!

secretstolen · 10-28-2007, 07:01 PM

I had the same problem. I work for a non-profit health organization that runs a hospital and multiple medical facilities in the area. I have insurance through work, which is a self-funded plan administered by Aetna.

When I called Aetna to find out, just to make sure I covered all my bases, I was told by the Aetna rep that there were many hoops I had to jump through in order to get the lap band covered. He even mailed me a copy of the documentation in their policy - which was about 30 pages - regarding bariatric surgery.

However, I had already talked to our benefits department who assured me that our insurance covered bariatric surgeries at 100% with no list of requirements to meet, other than what the bariatric surgeon requested prior to authorizing surgery.

The way a supervisor in our benefits department explained it is as such: The fact that my employer's insurance is a self-funded plan, of which Aetna merely administers, means that our policies and guidelines for certain services do not always adhere to those of general Aetna plans. Plus, the fact that we're a health organization also plays a slight part.

It could be that yours is similar. :)

Good luck!

Chrisann · 10-28-2007, 08:36 PM

I am the Benefits Administrator at my company. I called the customer service dept, not my rep. The customer service people didn't even answer the questions.

I then called the rep, and told him about it. I now get all the answers about the lap band surgery directly from him.

Your HR dept should call their direct rep with the insurance company, or at least email that person and BCC you. This is another case of the irresponsible training that insurance companies give their customer service reps.

If I wasn't a BA, then I would have taken the answers of the CS people. But I am too much of a driven person who doesn't take Bullshit too lightly. Make the HR people in your company earn their salary.