Coventry in Georgia?

[Pink Unicorn]

Hello,

Has anyone had a DS surgery using Coventry in Georgia? I think that insurance will pay for it, because our particular policy doesn't have a lot of hoops to jump through. But I am VERY nervous about this and would love to hear that someone else has done this before.

Thanks,
Pink

 

[Munchkin]

Are they an insurance provider? http://chcgeorgia.coventryhealthcare.com/

Get a real copy of your EOC(evidence of coverage) and read it! Don't rely on information you get over the phone. Or what someone else tells you.

 

[Pink Unicorn]

They are an insurance provider. I read my EOC and it says that all weight loss related procedures are not covered. BUT... when I called the Coventry representative said that bariatric surgery is covered if it's medically necessary. And so far, they haven't put up any crazy obstacles for me to jump over. I'm just nervous. And worried.

 

[southernlady]

They are an insurance provider. I read my EOC and it says that all weight loss related procedures are not covered. BUT... when I called the Coventry representative said that bariatric surgery is covered if it's medically necessary. And so far, they haven't put up any crazy obstacles for me to jump over. I'm just nervous. And worried.

Make sure when talking to them you get the persons name along with date and time. Tell them you are writing down what they said and repeat back to them what you wrote down.

 

[Settledownnow]

@Pink Unicorn this happened to me with Aetna. The website and representative on the phone said the surgery was covered, but my EOC said it was not. It was covered. I will keep my fingers crossed for you.

 

[Munchkin]

I think the medically necessary thing is on every EOC I have seen. Pretty standard!

 

[Pink Unicorn]

@Pink Unicorn this happened to me with Aetna. The website and representative on the phone said the surgery was covered, but my EOC said it was not. It was covered. I will keep my fingers crossed for you.

Thank you! Coventry is actually a part of Aetna, so hopefully it will be covered too.

 

[Pink Unicorn]

Make sure when talking to them you get the persons name along with date and time. Tell them you are writing down what they said and repeat back to them what you wrote down.

Yes, ma'am. For the record, I already did that, which is good because I'd be kicking myself now otherwise.

 

[Pink Unicorn]

I think the medically necessary thing is on every EOC I have seen. Pretty standard!

It should be, because in my opinion, health insurance should cover EVERYTHING that is medically necessary.

 

[DianaCox]

Now you need to fine the bariatric policy that applies to YOUR plan, either in the EOC or from the company, and post it here.

 

[Larra]

Re: medical necessity, your plan should spell out what they consider this to be - bmi, comorbidities, etc. Check specifics carefully, as some plans that "cover" bariatric surgery have different requirements for the DS than for other operations. Your EOC should also spell out your appeals rights, should you need to do any appeals.