ANOTHER ins. question

[Guest guest]

Hi Guys.

I am sooooo sorry to be asking tons of questions that may seem so trivial or

common sense to some of you, but I am in the process of making my appts. for

my physicals with my OB and etc. in order to have a " recent " /updated record

and such. I have called my ins. (Cigna Healthcare of NC) and asked them

point blank...did they cover weight loss surgery...etc....and of course they

don't.....that was a big a** surprise, (as it has been for most of us,

huh??!?!?!). Ok....well, it says that it doesn't cover it for the

" obese " ...not the " morbidly obese " so I have found what I hope is my first

" loop hole. " I talked to a really nice person in the other end of the phone

this time and I got her name and extension number if I need her again. I

am still moving forward with all my preparations for this surgery...I have a

few " hic-ups " I have to work out with my PCP first...so it might take a

little while, so I continue to plow on.

The question I have is this: While talking to the girl at Cigna, I asked her

what kind of account I had (since we have to put that on our online form) and

she said that I have a straight HMO. Another lady on here, Janice, has

CignaHCofNC and she has a POS plan that seems to be more flexible...she

doesn't have to have referrals and stuff. Well, under my HMO plan, I have to

be referred to pick my nose...I have to be referred for EVERYTHING!!!!!! It

is aggrovating actually. SOOOOOO, do I need to submit my online form to Dr.

R before I get reffered from my PCP to Dr. R's office? I mean, if I send the

form in via the internet, Dr. R sends a letter to Cigna, they will probably

refuse to pay just because I wasn't referred by my PCP before hand (under my

specific plan). See? So, from this point, what do I do? Go ahead and send

in the form to Dr. R and start getting my packet together, or go and see my

PCP first? The reason I ask is because it seems that everyone else has just

sent their form to Dr. R FIRST. I am afraid if I make an appt. w/ my PCP for

a " pre-op " physical, that the ins. will not want to pay for that

either.....(if they don't have prior knowledge of WHY I am needing the pr-op

physical) so in that case, I would need to go ahead with the online info to

Dr. R. Has this question even made any sense to anyone? I am so sorry it

has been long.

I am already getting my appeal letter ready...thanks so DebLaMan...(THANK

YOU). I am ready to fight these old insurance buzzards (as my grandma used

to say). I am getting my stuff together. I am MGB BOUND BABY!!!!! (One

day!!!)