Cigna Coverage

[Guest Hayley]

So I don't know if anyone or everyone has seen this pdf, but it's a document from Cigna insurance from this year clearly stating that SRS is covered. If anyone here has Cigna for a carrier, find out from your HR department or contact Cigna directly to inquire if they have this option on the coverage plan.

http://cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf

[JenniferB]

I. Know my company does. They are one of the most progressive companies and that makes a big difference. Still even with insurance SRS is very expensive unless in network.

Jenny

[Cyndee]

Thanks Hayley for sharing. I hope more companies adopt similar coverages.

Cynthia

[Guest Hayley]

I. Know my company does. They are one of the most progressive companies and that makes a big differwnce. Still even with insurance SRS is very expensive unless in network.

Jenny

Jenny,

I'm currently working with Cigna and I have as other done in the past, request that Cigna classify Dr. Bowers with an Out of Network Exclusion for the procedure. Being as Cigna does not have and cannot provide a surgeon that is In-Network, and as the procedure is covered, then they need to allow for an out of network surgeon at in-network rates.

[Guest Audrey Elizabeth]

Wow, Cigna is awesome to do that. To bad BCBS doesn't.

Audrey

[Guest Hayley]

Wow, Cigna is awesome to do that. To bad BCBS doesn't.

Audrey

Have you tried asking them to do that Audrey?

[Guest kelise]

That's what I have, and I can testify. I got my SRS last Oct with Dr. Bowers and didn't pay a dime outside of travel expenses and the $500 scheduling fee.

[JenniferB]

AJenny,

I'm currently working with Cigna and I have as other done in the past, request that Cigna classify Dr. Bowers with an Out of Network Exclusion for the procedure. Being as Cigna does not have and cannot provide a surgeon that is In-Network, and as the procedure is covered, then they need to allow for an out of network surgeon at in-network rates.

I called Marci's office in Trinidad earlier this year and they said that when Marci's practice was. Located in Trinidad it was covered by Cigna. Now that she is in San Metao you are correct, SRS is an exception even though not in network.

I will not be eligible for surgery until next summer at the earliest. Then there is the waiting liist. I hope she will still cover in network at that time and I atill have my job.

Jenny

[Guest Audrey Elizabeth]

Have you tried asking them to do that Audrey?

No I have not. I am not that far along but I read through the material and it was one of the excluded items.

[Guest Hayley]

Kelise,

How long was your waiting time, seeing as insurance was involved. Correct me if i'm wrong but I imagine that when insurance is paying for it, it can't be too far out, as approvals usually have time limits on them.

[Guest kelise]

I scheduled my date in July, had my surgery in Oct. Could have had it in August, but couldn't get travel funds together in time.

[Guest Donna Jean]

.

Everyone.....

Please be careful....

Just because you may have CIGNA (or any other plan) it does not mean that SRS will be covered...

Companies that we work for buy insurance coverage through Insurance companies...

BUT! They do not always buy the best plans...Insurance companies offer companies several plans at several costs.

They only way to be sure if you're covered is to read the material that comes with YOUR specific plan!

Make sure that you know what you're covered for so you won't be disappointed in the future!

The insurance plan that I had specifically said "NO SEX CHANGE"...rather crude, but, that was the wording in the manual!

Be careful....ok?

Huggs

Donna Jean

[JenniferB]

I called Cigna and told them what company I worked for. It took them a little while to get back with me and they told me I was covered. Dee Jay is right, not all companies cover SRS and I don't know any who cover any cosmetic surgery.

Jenny

[Guest Hayley]

.

Everyone.....

Please be careful....

Just because you may have CIGNA (or any other plan) it does not mean that SRS will be covered...

Companies that we work for buy insurance coverage through Insurance companies...

BUT! They do not always buy the best plans...Insurance companies offer companies several plans at several costs.

They only way to be sure if you're covered is to read the material that comes with YOUR specific plan!

Donna,

Thats why I specfied to contact your HR department and/or carrier and confirm that they have that option on the plan.

If anyone here has Cigna for a carrier, find out from your HR department or contact Cigna directly to inquire if they have this option on the coverage plan.

[Guest Hayley]

Well! It turns out that things aren't quite so clear cut as i'd imagined it'd be......Yet! Cigna now has all my necessary information and everything required for approval. I am waiting on that now which can take up to 15 Business days, however i'm told that it's being rushed for me as i've been put through hoops for this. What is not so cut and dry is wether or not Cigna will ok the Out of Network Exception for Dr. Bowers, considering her In-Network for SRS on a one time basis. Their argument is that my plan doesn't require me to use ONLY In-Network surgeons, i'm also provided access to Out-Of-Network access as well. If it turns out they don't approve the exception, Cigna will have to give me the number they consider Usual and Customary (if they can't negotiate with Dr. Bowers) and I will have to pay any difference between Dr. Bowers cost and the U&C charge + 20% of the U&C up to 2k dollars. God knows what that number can actually be!!! Scaring me. I pray they come through and ok the exception and then life is grand, if they don't, then i'm up a creek.

Interestingly enough they said they couldn't tell me if they'd approve the exception until after I got the approval for SRS. So it's a waiting game now. Keeping my fingers starred.

Wish me luck and send your prayers (in thoughts).

[Guest Erin Quinn]

.

Everyone.....

Please be careful....

Just because you may have CIGNA (or any other plan) it does not mean that SRS will be covered...

Companies that we work for buy insurance coverage through Insurance companies...

BUT! They do not always buy the best plans...Insurance companies offer companies several plans at several costs.

They only way to be sure if you're covered is to read the material that comes with YOUR specific plan!

Make sure that you know what you're covered for so you won't be disappointed in the future!

The insurance plan that I had specifically said "NO SEX CHANGE"...rather crude, but, that was the wording in the manual!

Be careful....ok?

Huggs

Donna Jean

Have to agree here, though I'm so happy for those who have been able to work with the insurance company to cover some/all of the costs I currently work for a major company, and while all the public info states they cover SRS, I'm still struggling with my provider (United Healthcare) to get them to cover my surgery. Just getting the materials from them that state wither or not they cover SRS can be a pain, these companies want to give us as little information as possible and leave us needing their help.

[Guest Hayley]

I just spoke to my Client Service Partner at Cigna who is working to get my approval processed for surgery, and he had two pieces of news.

One, he said that Dr. Bowers is In-Network!

Two, he saw an initial view of denied for the request, however no details of any kind, despite my meeting all the requirements. He is talking to the authorization department today to find out why as the record does not make any sense. I'm praying he can get it sorted out and I end the day with an approval. If he can, then I will but have to pay 500 dollars to schedule my date, and may have to pay 500 dollars co-insurance for the hospital stay. But that would be after the fact.

If he can't get it straightened out for whatever reason, then I would have to appeal and if that still got denied, it would go to a peer review. They would have to discuss it with my physicians and establish the medical necessity that way!

Pray for me!

Hayley R.

[Guest kelise]

I just spoke to my Client Service Partner at Cigna who is working to get my approval processed for surgery, and he had two pieces of news.

One, he said that Dr. Bowers is In-Network!

Two, he saw an initial view of denied for the request, however no details of any kind, despite my meeting all the requirements. He is talking to the authorization department today to find out why as the record does not make any sense. I'm praying he can get it sorted out and I end the day with an approval. If he can, then I will but have to pay 500 dollars to schedule my date, and may have to pay 500 dollars co-insurance for the hospital stay. But that would be after the fact.

If he can't get it straightened out for whatever reason, then I would have to appeal and if that still got denied, it would go to a peer review. They would have to discuss it with my physicians and establish the medical necessity that way!

Pray for me!

Hayley R.

Ah, so they DID just end up enrolling Dr. Bowers into the network! I had to go the route of proving they had no in-network doctors to treat me, so they had to use an out-of-network doctor and treat them as an in-network. It was a hassle, and there was talk that once my case was sorted out they would consider formally including Dr. Bowers into the network.

Good luck, hun. I went through all this red-tape stress too. You'll get there, I know it!

[Guest Hayley]

Well my news so far is not good. :/ I spoke with my contact at Cigna who told me they denied the authorization on the grounds that some information was incomplete, but could not say WHAT information.

They are really playing games with me!

[Guest kelise]

Keep on them. Call every day if you have to, until they tell you what information they still need.

[Guest Hayley]

Even my client advocate doesn't know what we need! He said he spoke to the supervisor of the Authorizations department and when he asked what was missing, she floundered!

[Guest Hayley]

Update on my insurance battle!

So after a back and forth between my Client Advocate at Cigna and Cigna Medical Directors, the long awaited reason for denials so far....Drum roll please?..Disagreement over outpatient and/or number of days hospital stay required! Seriously!? B*tches and H*es! Honestly, you'd think they would have looked around at a few other surgeons claims before fighting tooth and nail over number of days in the hospital like that! So it's going to come down to a peer-to-peer review, for which i'm feeling quite a bit more confident will ultimately end with the approval I was waiting for!

I'm feeling good about this and have put myself in preparing for surgery mode. I'm praying my hopes don't get dashed once again.

[JenniferB]

Update on my insurance battle!

So after a back and forth between my Client Advocate at Cigna and Cigna Medical Directors, the long awaited reason for denials so far....Drum roll please?..Disagreement over outpatient and/or number of days hospital stay required! Seriously!? B*tches and H*es! Honestly, you'd think they would have looked around at a few other surgeons claims before fighting tooth and nail over number of days in the hospital like that! So it's going to come down to a peer-to-peer review, for which i'm feeling quite a bit more confident will ultimately end with the approval I was waiting for!

I'm feeling good about this and have put myself in preparing for surgery mode. I'm praying my hopes don't get dashed once again.

All of us are keeping out fingers crossed that you will be accepted for surgery. But days in the hospital? Are they thinking one or two? Wow!

Are you keeping a journal about every game Cigna is playing? The reason I ask is I have Cigna which includes SRS as a covered by insurance. It would make it easier to know what to expect and the process you took to deal with it.

Jenny

[Guest kelise]

That's so weird. Is there a Morning After House in San Mateo. I know that in Trinidad, before the MAH came along they kept you in the hospital an extra day or two. Could it be that since they have a 4 day stay in St Mt Rafael Hospital on record from me, perhaps a longer stay in San Mateo might be raising a red flag?

[Guest Hayley]

So according to Cigna they see it as an Outpatient surgery requiring at most 23 hours of observation. Dr. Bowers submitted for 3 days of hospital before being transferred to the Morning After house.