Sooooooo Disappointed And Frustrated!

[xavtay2 85]

Hello everyone,

I recieved a call today from the drs office to inform me that my surgery was approved! While she talking to me she said that something didn't look right and she was going to have to call me back.. Well she just called back and guess what.....My insurance company sent them the approval yesterday via fax but faxed again to say that it was denied....!!!!! When she called the insurance company, which by the way I have CIGNA, she was told that the hospital for surgery has to be a certified center of excellence for Bariatric surgery. Apparently the doctor was okay but the normal hospital that he does over 95% of surgeries from is not an approved Center according to them.

I am sooooo disappointed and frustrated!~ So now I have to wait for them to send the precertification again... I just have to believe that everything happens for a reason but did any of you go thru anything like this????

Blann

[Sojourner 2,446]

Hello everyone,

I recieved a call today from the drs office to inform me that my surgery was approved! While she talking to me she said that something didn't look right and she was going to have to call me back.. Well she just called back and guess what.....My insurance company sent them the approval yesterday via fax but faxed again to say that it was denied....!!!!! When she called the insurance company, which by the way I have CIGNA, she was told that the hospital for surgery has to be a certified center of excellence for Bariatric surgery. Apparently the doctor was okay but the normal hospital that he does over 95% of surgeries from is not an approved Center according to them.

I am sooooo disappointed and frustrated!~ So now I have to wait for them to send the precertification again... I just have to believe that everything happens for a reason but did any of you go thru anything like this????

Blann

What you have shared is not unusual...it's just like being given a list of "in network providers" by your insurance company. It can be a PITA, but should not be too difficult to manage.

My only experience with the hospital choice has been with a "Center of Excellence" designated bariatric program. And IMHO, you will be better off for having your surgery at such a designated center. I write that because from reading what so many other participants on this forum have written, they have the surgery and then are fending for themselves to understand and discover what they need to do for proper self care and nutrition.

The Center of Excellence I had my surgery at required nutrition education though out the pre and post op journey. There is a surgery specific manual I was given at the pre op class, and it has been referred to many times. The manual takes you through every stage pre op through attaining and maintaining your goal weight.

They prescribed the post op medications I needed prior to the surgery, so I would have them at the house, and there was no need to become anxious. Through their education and pre op preparation, I knew what to expect, had the means to manage my condition, and had the phone numbers for 24/7 coverage should there be concerns.

Again, IMHO, that is the difference in hospitals. I may be a bit prejudiced about the experience I have had with my surgeon and hospital, but that comes only from the positive experience I have had. And I strongly believe that it is the education and preparation which has made such a positive difference for me.

Your mileage may vary...in any case, best wishes as you continue your preparations for your weight loss journey!

[xavtay2 85]

Thanks so much Lap Band Guru! I appreciate you taking the time because I was just looking at it the wrong way. Now that you have explained it and I look at it you are right it is a benefit to be having surgery at a center of EXCELLENCE! Great information and thanks for sharing your experience because it helped me.

Blann

[Fantasy 104]

Hang in there, before you know it you will have had your surgery and be nice and slender. I can't believe it will be 7 years in August for me. The time goes by so fast. Let me rephrase it, the weight came off slow, the time went by fast. At least the weight stayed off. Good luck.

[BarbeeM 5]

Oh I agree, you want to have it at a place that has high standards. So happy that is what your insurance company wants too. They want the best for you. I know you are a little disappointed with the set back, but I believe God is in control.

[Ready for the change 40]

What you have shared is not unusual...it's just like being given a list of "in network providers" by your insurance company. It can be a PITA, but should not be too difficult to manage.

My only experience with the hospital choice has been with a "Center of Excellence" designated bariatric program. And IMHO, you will be better off for having your surgery at such a designated center. I write that because from reading what so many other participants on this forum have written, they have the surgery and then are fending for themselves to understand and discover what they need to do for proper self care and nutrition.

The Center of Excellence I had my surgery at required nutrition education though out the pre and post op journey. There is a surgery specific manual I was given at the pre op class, and it has been referred to many times. The manual takes you through every stage pre op through attaining and maintaining your goal weight.

They prescribed the post op medications I needed prior to the surgery, so I would have them at the house, and there was no need to become anxious. Through their education and pre op preparation, I knew what to expect, had the means to manage my condition, and had the phone numbers for 24/7 coverage should there be concerns.

Again, IMHO, that is the difference in hospitals. I may be a bit prejudiced about the experience I have had with my surgeon and hospital, but that comes only from the positive experience I have had. And I strongly believe that it is the education and preparation which has made such a positive difference for me.

Your mileage may vary...in any case, best wishes as you continue your preparations for your weight loss journey!

my insurandce tried to tell me the samething so i had them cancel my appt and just had the hospital approve it i was approved in 3 days. the hospital they wanted me to go through made alot of errors and were in the news about the errors...dont give up

[fericito 138]

I'm glad you feel better about things and you're right, it all happens for a reason.

[xavtay2 85]

Thanks Fantasy5! Congratulations on your size 6...wow way to go. Thanks BarbeeM, you are right GOD is in control! Thanks ready for a change, just so I am understanding you correctly you had the hospital become a certified center of excellence and then went back and it was approved>please explain. If that is what you are saying I saw the paperwork on line and if that is the route then maybe the dors office can help me do that with the hospital or atleast point me in the right direction.... Fericito, thanks for your response and I am trying my best to feel better but it is so hard! However, I do know and believe that God has total control and everything does happen for a reason.

[Bel12 13]

I went through something similar. I went to a hospital in my town that does the Lapband and filled out all the paper work and the insurance company said no because they weren't as certified as this other hospital 2 hours away. After researching in glad they turned me down bc the hospital I was going to get it down at had only 10 surgeries performed while the one 2 hours a away has done hundreds ever thousands. It all happens for a reason.

[NWgirl 574]

my insurandce tried to tell me the samething so i had them cancel my appt and just had the hospital approve it i was approved in 3 days. the hospital they wanted me to go through made alot of errors and were in the news about the errors...dont give up

If you used insurance, they have to approve the facility your are receiving surgery in, not the hospital. Does this mean you did out-of-network because the insurance would not let you go where you wanted to go?

[Ready for the change 40]

If you used insurance' date=' they have to approve the facility your are receiving surgery in, not the hospital. Does this mean you did out-of-network because the insurance would not let you go where you wanted to go?[/quote']

Yes I went out of network. But they kept trying to push for one in network a lot so I told them to cancel and I let the hospital submit it over lol and approve soon. They were even trying not to pay the nutritionist either or the phys

[xavtay2 85]

Hello everyone just a quick update!

As it stands I am fighting my denied precertification claim with CIGNA! they really suck. Turns out they denied me because none of the hospitals that my doctor operates are CIGNA certified.

Several issues I am dealing with:

There is only 1 hospital in the state of FL that is "CIGNA CERTIFIED"! This hospital is in the MIAMI and I live in central FL about a 4 hour difference

Both hospitals are listed on the Cigna website and in-network and one is even shown under their (CENTER OF EXCELLENCE) tab.

When I called and spoke to a specialist in precertification I was told that they are using a list of CIGNA certified hospital dating back to October 2011! (really)

Lastly, CIGNA had originally contacted my doctors office to say that the one hospital on the website was approved but then all of a sudden they changed it and said no it wasn't!

I feel like I am in the fight of my life and nobody understands. I have filed a complaint with the FL deparment of insurance and our internal HR advocate. Both agencies will be contacting CIGNA on my behalf to have this resolved. I will keep fighting until I am approved. Just prayerfully it will be soon.

This is crazy but I know that it will be resolved.... thanks for all of your posts thus far and I wanted to give you an update

[adorkbl 156]

I have filed a complaint with the FL deparment of insurance and our internal HR advocate. Both agencies will be contacting CIGNA on my behalf to have this resolved. I will keep fighting until I am approved. Just prayerfully it will be soon.

Wow!! You go girl!!! I hope it works out for you. Hang in there!!

[NWgirl 574]

Hello everyone just a quick update!

As it stands I am fighting my denied precertification claim with CIGNA! they really suck. Turns out they denied me because none of the hospitals that my doctor operates are CIGNA certified.

Several issues I am dealing with:

There is only 1 hospital in the state of FL that is "CIGNA CERTIFIED"! This hospital is in the MIAMI and I live in central FL about a 4 hour difference

Both hospitals are listed on the Cigna website and in-network and one is even shown under their (CENTER OF EXCELLENCE) tab.

When I called and spoke to a specialist in precertification I was told that they are using a list of CIGNA certified hospital dating back to October 2011! (really)

Lastly' date=' CIGNA had originally contacted my doctors office to say that the one hospital on the website was approved but then all of a sudden they changed it and said no it wasn't!

I feel like I am in the fight of my life and nobody understands. I have filed a complaint with the FL deparment of insurance and our internal HR advocate. Both agencies will be contacting CIGNA on my behalf to have this resolved. I will keep fighting until I am approved. Just prayerfully it will be soon.

This is crazy but I know that it will be resolved.... thanks for all of your posts thus far and I wanted to give you an update[/quote']

I know with my insurance, they only approve for center of excellence locations. Is that the one 4 hours from you? if so, that's probably why you were denied. At least it's good to know it's only for the location and not a medical denial...