Help with Getting Insurance Information

[sarahbear]

I'm in touch with Meltzer's office but they said they need me to get the insurance documents that show that GRS is covered. I called in the past and confirmed that the specific code for GRS is covered but in terms of getting the plan documents I can only do that through my HR. I called Cigna but they said they have nothing and their information page for customers is really unspecific as well.

Do HR departments generally allow employees to have the plan documents and/or are they required to give detailed plan documents? It seems like this would be a requirement that anyone on a plan be able to look at the specific details of it rather than general summaries.

[Michelle.]

Ask your HR person for your specific plans "packet". You should have gotten one from the beginning.

[Adabelle]

Just start the pre approval process with Cigna and they will send you a letter on the mail. They have a bunch of hoops you have to go through. They don't just pay for it, there is a process and you will be assigned a case manager. They will then inform the doctors office or you can show the doctor your approval letter.

Your hr person can tell you who to contact.

[sarahbear]

Adabelle, should I ask HR how to contact Cigna for a pre-approval case manager or something else?

Michelle, I'm going to double check the information they gave us for the health plan but I'm pretty sure they're not very specific just general stuff like deductions and what you percentage you pay for different kinds of things they cover.

[Adabelle]

Yes. Ultimately HR is the only people who are going to know your plan and what is covered and what is not. You just need to ask your HR person what the process is for getting preapproval for the surgery and then take their advice. More than likely if they don't know they will get in touch with the Cigna person who manages your company's account and they will certainly know where to point you. In my case I was put in touch with that account manager for my company's plan, and then I was assigned a case manager by them who helped me through all the paperwork. You'll have to get two psychological letters, and prove you've been on HRT for a year, and a bunch of other stuff too but the case manager will tell you what you need. Get started on it soon because it takes time to work through the process and get it approved.

Adabelle, should I ask HR how to contact Cigna for a pre-approval case manager or something else?

Michelle, I'm going to double check the information they gave us for the health plan but I'm pretty sure they're not very specific just general stuff like deductions and what you percentage you pay for different kinds of things they cover.