ML in VA

Tricare will deny if they Cigna says its not medically necessary so I'm out as far as insurance is considerd. Already in process of looking at loans, HarleyNana. WLSC has a date available the first week in August so I'm shooting for that!

I got word today that Cigna (primary insurance) denied me due to lack of medical necessity and 24 month BMI. I called Tricare (my secondary insurance) and was told that a referral is not needed and all my surgeon has to do is submit the authorization. Can it be that easy?? Not getting my hopes up. You would think it would be easier with 2 insurance plans, but it sure isn't.:embaressed_smile:

I'm actually dealing with primary/seconday insurance issues right now. I got word today that Cigna (primary) denied me due to lack of medical necessity and 24 month BMI. I called Tricare and was told that a referral is not needed and all my surgeon has to do is submit the authorization. Can it be that easy?? Not getting my hopes up. You would think it would be easier with 2 insurance plans, but it sure isn't. :embaressed_smile:

Its been an experience - they wanted to see my 5 year weight history, a 6-month doctor supervised diet program, a nutritional consult, a psych consult and a letter from my pcp recommending surgery. You also need to have a BMI over 40 (mine is 41). With all this info, I"ve still heard horror stories about denials left and right. So, we shall see.

Thanks for all your support!

Hi WW, I'm new to these boards and am currently awaiting approval from the insurance Gods - so no date yet. I'm having my surgery at WLSC in Newport News VA. Looking forward to learning from our VA Bandsters! ML cw 280 gw 160

Thanks for checking in, HarleyNana. No word yet. My case is "pending review" with Cigna. No idea what that means. Wondering if Cigna will call me or my surgeon first with news of approval or denial. Ugh! I hate the waiting game. These boards have been a God send!

Hi Cathychatts, I was so encouraged to read your post. I too, have Cigna Open Access and am awaiting approval from Cigna. I call the automated system at least twice a day to check my authorization. I get transferred to customer service, who tell me that it is "pending review." You were approved so quickly; I'm thinking that it may not be looking so good for me since its now been almost 7 days.

Thanks, Donna. Wow...10 days out! If you're willing to share, I'd love to hear about your overall experience from dealing with the folks at WLSC through to the surgery. Thanks again!

Thanks for the advice. I didn't think I had a choice on which surgeon. I assume that once I'm approved I'll get appointments scheduled to meet them.

Hi Diane and thanks for the welcome, I am actually on pins and needles awaiting insurance approval. Do you think it's strange that I havent met my surgeon yet? Dr. Terracina was at a conference when I went to the seminar last month so I only got to meet Dewey his PA. I've heard great things about Dr. Clark. Did you find that the insurance coordinator was pretty on top of things to get you approved? Sorry for all the questions! ML

Pix, Great question about why they didn't submit to both. I suspect it must have something to do about the negotiated rates for the surgeon; Cigna may pay more than Tricare? I will certainly ask about this once I get some word on my approval from Cigna. I have Tricare Prime, but I'm a little concerned that they may not approve my referral to the surgeon I've selected since they perform lap band surgery on base (not too far from me). I'm just very familiar with the surgeon I've selected and love the hospital he's affiliated. So this may be another hurdle to overcome if I get denied.

I have Cigna Open Access as primary insurance and Tricare Prime as secondary. Does anyone know if Tricare will automatically approve me if Cigna denies me. My surgeon has submitted everything to Cigna (6 month diet, psych eval, nutrition consult, etc.). Tricare only requires 200% over ideal body weight - which I am. It would have been so easy if I didn't have Cigna. I'm wondering if I'll have to start all over again if Cigna denies me (e.g. referral from PCM). Any help or advice would truly be appreciated. Thanks, ML

I'm ML from VA Beach. I'm having my surgery at WLSC - not sure who my surgeon is since I've been going through all the insurance requirements before they can submit everything to Cigna. I'm hoping to get banded in August. Very excited!

Thanks. It is incredible how difficult it is to work with the insurance companies and how different they all are. I can't wait to be able to post that I'm approved and ultimately banded like you! :thumbup:

Thanks so much for your reply. My current surgeon does accept Tricare so I'm hoping that all I'll need to do is have him submit the denial info to Tricare in order for them to approve. I'm so anxious to move this forward. These boards have been a god send.

Hello all, First let me say this board has been a God send and so comforting to hear from folks on the same journey. Not sure if anyone can help with this one. I currently have 2 forms of insurance: Cigna Open Access (primary) and Tricare Prime (secondary). Cigna wants the 6 month diet, 5 years of documented weight, psych and nutritionist eval. Tricare on the other hand only wants a BMI over 40...which I have. Here's my question...if Cigna denies me, will Tricare automatically cover me? The WLS can only tell me that if Cigna denies me, we'll have to "start all over." Huh? Anyone with a similar co-insurance experience. Thanks! ML in VA:confused_smile: