Re: PruCare/Aetna HMO or CIGNA PPO -- Which is better???

[Guest guest]

Diane

I'm not an insurance professional - but first of all I

would call both of those insurance companies and ask

if Dr. Rutledge is in their provider book. Even if

you don't need a referral you usually still have to

choose a dr in their " plan " . Can you find out if

they exclude weight loss surgery? Find out their

requirements for weight loss surgery. I have Aetna

and while Dr. Rutledge is out of my area (St. Louis)

he is an Aetna provider and my plan has " reciprocity "

which was determined by my employer. So I am covered

90%.

Don't give up even if one person tells you no. Many

of those insurance people (sorry, insurance people!!)

don't know what is going on or are too lazy to find

out. I had to speak to 4 different people just to get

the fax number!!! Duh??

Write down every person's name and, if possible, an

extension number. If you don't get informed answers

ask to speak to the supervisor.

Even people with the same insurance company have

different coverages - all decided by the individual

employer.

But get on that phone NOW and start asking questions

so you can make an informed decision by Friday. Take

lots of notes.

Good luck!!

Margaret in St. Louis

--- dianedeforest@... wrote:

> Help!!! I currently have the PruCare HMO (now owned

> by Aetna), and

> was told that they probably would not approve me

> because I'm not in

> the Durham area. So, I recently elected to change

> to the CIGNA PPO

> as of 1/1/01 -- thinking that a PPO would be easier

> to work with

> (i.e. -- no referral from PCP required, etc.)

>

> But, now I see postings that people have had

> problems with CIGNA,

> too. Has anyone outside of NC been successful in

> having this surgery

> covered by the PruCare/Aetna HMO? How about the

> CIGNA PPO outside of

> NC?

>

> I only have until Friday to make a final decision,

> so I really need

> help fast!

>

> Thanks-

>

> Diane

> Nashville, TN

>

>

>

>