Denied For Gastric Sleeve Surgery.... Anyone Had This Happen?

[koriswlj 66]

I was denied today because Cigna decided to tell my Bariatric center at the last minute that I had to have my surgery done at a hospital that was a "Center of Excellence". So they gave me the doctor and hospital I have to use. My bariatric office was so mad because they never once caught that when they reviewed my benefits at Cigna. They told me that I am pre-approved through Cigna. So I am hoping that when I get an appointment with this doctor.. The office said they will fax everything over. I did everything I needed to so I hope it gets approved quick.

If anyone has been through something similar I would love some feedback.

[gracemarie 6]

That is not unususal at all and really your first place should have known that. If you have all your requirements in it should not be an issue to switch centers...

[indi1 66]

I actually had something like this happen a couple weeks ago, but reversed somewhat. I was trying to set something up with a surgeon who was in the BCBS ppo "network". The surgeons office told me they couldn't do the surgery because they were not a "blue distinction" center. I called the insurance company and they told me that it was absolutely not true. Any surgeon could do it as long as they were in the "network". Right now, I am just trying to get the approval but I have pasted below what my insurance company states about it on their website. So, I know this doesn't help much but thought I would share.

"

BCBSIL member participation is voluntary. Members whose benefit plan includes coverage for bariatric surgery will be advised of the Blue Distinction Centers for Bariatric Surgery; however, depending upon the member's benefit design, the member may be able to choose other contracted facilities without penalty. The member must complete a medical weight management program and satisfy all other criteria in the medical policy regarding Surgery for Morbid Obesity before bariatric surgery can be considered. When using a Blue Distinction Center for Bariatric Surgery, members should confirm that the surgeon is part of the contracting network by calling Customer Service. Members will not receive in-network benefits for the services of surgeons or other providers who are not in the contracted provider network of the member's health plan."