Shelby

I live in Texas too. Keep calling Cigna for updates - not all Cigna Reps are very helpful but every once in a while you get someone who seems like they are really trying to help. Good Luck to you - let me know when you hear something.

I don't have Medical Mutual of Ohio but I understand what it feels like to wait - it's painful. Hang in there! I hope everything works out for you!

My surgeon and Cigna are playing phone tag - it's been a week now. I'm hoping this can be resolved within the next few days! So the saga continues :-) I didn't have to take a colonoscopy or an endoscopy - maybe that could be a requirement from your surgeon prior to surgery. And... this hurts.... but in my experience Cigna takes the full amount of time to respond. Cigna's 30 days is actually 30 business days! It's painful waiting that long! Thanks for your responses - I'll let you know as soon as I hear something!

I have completed all of Cigna's requirements and LapBand is covered on my policy. My surgeon's office sent off the paperwork for approval just before Christmas. Cigna has until Fri 2/2 to respond - 30 business days. I called today (my 5th call this month) and it is being 'reviewed by a Medical MD" since 1/24. Most days I have the attitute that what is meant for me won't go by me and other days I'm happy there is the appeal process in case I need to use it. But today I'm worried... Is this a good thing that a Medical MD is reviewing my case?

I went to my PCP every month for 6 months and she wrote 2 letters for me which I also submitted. Ihave complete support of my PCP. When I think of co-morbidites I think of diabetes, sleep apnea, etc. I do have joint pain (knees), bad back, swollen ankles, high cholestrol which was also noted in the paperwork submitted to Cigna. My surgeons office said there is a lawyer she could refer me too. Once I have the denial letter in my hand and also in the surgeons insurance coordinators hand - we'll get a game plan. But this I know for sure - I have met all Cigna's requirements - my policy covers the surgery - I will appeal. I just feel really down now - I'm not at the pissed stage yet but I"ll get there soon :-) Thanks for all your support!

I just called Cigna and I've been denied. Was actually denied on 1/23 - of course I've called everyday since 1/22 and this is the first I'm hearing of a denial. Seems I don't have enough health issues even thought my BMI is 43 and something about my 6 month doctors care paperwork. I'll have to wait for the letter (which will be sent tomorrow) because the gal I was talking with was annoying me! I don't get it!! My insurance covers BMI over 40 with no health issues (can't think of what it's called at the moment). I have a list of stuff but I don't have diabetes, heart condition, high blood pressure, sleep apnea, etc. I can't believe this. Ok... next... I'm appealing! Wish me luck! I'm gotta go cry now...

Sorry to hear this Bill - hopefully your HR person will be able to help.

Thanks for the support! It truly does help. Kathyy68 - I had a dream about Cigna last night -- too funny! I just wish I could remember how it ended :-) Good Luck to you!

Thanks Missy22! It's really getting to me today - my patience has run out :-)

This process is so frustrating and emotional but I'm not giving up. I have Cigna Insurance -- the lapband is covered in my policy and I meet all of their criteria but am still denied. The first denial was because my surgeons office didn't submit all of my doctors files - yup! I was denied for stupidity :-) The 2nd time we submitted the info I was right there at the fax machine so I knew that everything was submitted. But when I called Cigna this morning I was told my appeal has been upheld. They couldn't tell me why and will have to wait for the letter from the National Appeals Unit in California. I've been working on this for a year now - since March 05 (Surgeon Seminar, surgeon appt, 6 month primary physician appts, pysc eval, nutrientist, sleep apena study, upper GI tests, denial/appeal) and my appeal is upheld - I don't get it. My plan is to wait for the letter and appeal it again. This is my health we're dealing with and I'm not going away or giving up.

Thanks Alexandra. I received the letter from Cigna and it was about as clear as mud! The letter was regarding gastric bypass surgery @#$%! and it said if I wanted to submit more info they will look at it but it was not an appeal nor was it a denial letter either -- it was completely the wrong letter! I called Cigna and was able to speak with a rep who sounded like she knew the process. She agreed - the wrong letter was sent. Because LapBand is an outpatient surgery there is not appeal process for pre-determination (only in-patient surgery has an appeal process). My info was sent to the appeal unit because I included my 1st denial letter with my package (I was just following what the letter said) and one look at the denial letter and it was shipped to appeal. Oh boy. So now my plan of attack is re-submit without including any Cigna letters. Along with a letter from me to Cigna -- I'll write it this weekend and fax everything (again) to Cigna and wait another 30 days for a response. Wish me luck! Disneynut - my surgeons office has a Lapband Coordinator who is helping. But take my advice - make sure your sister is all over the details even with the coordinator (I had to learn my lesson the hard way). And yes the surgeon will receive the same letter your sister does from her insurance company. Sounds like she is falling between the cracks -- may require a walk in chat. Speak up - get involved - stay on top of it. Best of luck to her and to you for being a great supportive sister!

Congratulations!!!

Kelly thanks for sharing - you look great.

I also have Cigna as well and was denied because my surgeons office forgot to include my 6 month PCP report. Now I'm denied again from my 1st appeal -- just waiting for the letter to find out what the reason is for this denial. Cigna couldn't tell me over the phone. It's all very frustrating but don't give up! Go monthly to your PCP -- time flies and before you know it you would have completed your 6 month requirement.

Hang in there -- I know it's frustrating as heck but you will get thru this.

36% A definite yankee. And I wonder why I sometimes feel like a big thumb in Texas :-)

Congratulations! I'm very happy for you!

Thanks for your help and support. I will keep you updated.

Hang in there! Keep in contact with your surgerons office and feel confident that you have done everything you can do. What's meant for you - won't go by you!

Congratulations on your approval! I am waiting approval now and hopefully will be scheduling surgery with Dr. Hagood. A friend of mine used Dr. Hagood and also used him for other surgeries as well. I don't know about you - but I like the fact that he performs all types of surgeries. Best of luck to you!

I tend to read more than I post here but I just wanted to say how cool this site is! Aligirrl77 needed support and bam - she found it. The kindness and support of everyone on this site is just amazing!

Stay involved Leenerbups and double check everything. The coordinators are not walking in our shoes and have no idea how we feel. It does make ya wonder if the office can't keep things organized - it has to affect the surgeons in some way. How can it not?

This is my first post and hopefully I will be among the banded soon! My insurance covers lap band; I meet their criteria; I have meet all the requirements; I am confident with my surgeon's abilities. My concern is the level of attention to detail within his office. Yesterday I found out I was denied because the Lap Band Coordinator did not include all the reports. Also found out they never requested these documents when I finished my '6 months of physician directed weight loss' in October! I thought I was involved. I thought I was on top of things. I thought everything was on track. I didn't expect to be denied. And I certainly didn't expect to be told when they sent my documents for approval it was not even read before hand!! Lesson learned... I am sooooo all over this! She may have thrown away my 1st request but she will not throw away my health and happiness.

Thank you for your advice and support. My plan is to reponse to each item on my denial letter which means I need another appt with my PCP so her comments can be entered into my file. I'm not just submitting the missing PCP report as the surgeons office suggested... the denial letter is asking for so much more. Then I will physically be in their office in front of the fax sending the documents - after everything is checked and doubled check. The coordinator is really working with me and I feel better about that. I've tried to talk to the surgeon but didn't get passed his assistant. I will talk to the doc - he's a great surgeon. It's too bad I had to become a speaky wheel in order for my claim to be handled properly.

It's just so frustrating isn't it. I understand human error and I'm trying to move on. But I'm having a hard time accepting that this is normal and because of the volume it's an acceptable mistake. I am guessing that I'm not the only one getting denied because of their volume! Thanks for responding. I feel better just knowing other folks understand how I feel. I am so glad I found lapbandtalk! And if this is for me - it won't go by me!!