Like Walking Over Hot Coals

[BABEwiththePOWER 16]

I posted another thread on this a while back when I was awaiting the decision from Cigna on my first appeal... well, that appeal was denied...on the basis of me "not providing documentation of a physician supervised 6-month weight loss program." Funny thing about that is, I DID! My doctor's office even kept records of what they sent, and it was part of the packet. In fact, I waited to resubmit my appeal until my 6-month program was completed and documented.

After going round and round in circles with literally dozens of Cigna people, my doctor's office got a fax number of someone in appeals who was willing to look at just the "missing information." So, they faxed it over, and were told it would be another 2 weeks before we would hear if they accepted the documentation...Well, when I called to check in on it, they said it was pending, and to call back the next week. I did. That's when things got crazy.

They told me it wasn't pending at all, and in fact, it had already been elevated a level, and they were waiting on ME to sign an IRO form (Independent Review Org), so they could release my records to the external reviewers. Seriously. Just because they SAID they didn't receive the info the first time, and they apparently couldn't just look at the information when sent to them AGAIN... holy crap.

Anyway, I finally got in touch with the woman who sent me the IRO forms, (to the wrong address, no less), and I immediately emailed the signed docs back to her. She said this was the final final final verdict, and whatever the IRO decided, was what Cigna would have to uphold. Oh yeah, and it could take weeks before I heard back.

Luckily, I had this woman's personal Cigna email, so I was able to "check in" with her every few days. I had just basically given up on all of it, even though I rescheduled my surgery for 4/19, for other reasons, I didn't think Cigna would pan out in time, or even at all. On Monday, I emailed the woman there, and didn't hear back. Well, Tuesday morning, at 4:35am, she emailed me and said I was approved.

Seriously. APPROVED. I couldn't believe it. But man, am I glad I jumped through all the hoops. I really think they expect you to give up, after they deny you for whatever arbitrary reason, even a reason that was completely false, like mine. I took this thing all the way. Even though it was a pain in the butt, in the end, it worked out. And, I saved myself $17K. whew.

Long winded story, but really, take it as an inspirational one. Cigna has the worst reputation when it comes to VSG approval, but just don't let them off the hook. Take it all the way. Make them do their job. Make them pay!

Good luck to all the others out there going through insurance approval hell. I hope for a good outcome for everyone.

[slimthickens 28]

Congrats to you for fighting for your right to have the medical treatment that you deserve after paying into their inflated costs of healthcare. I've always said that health insurance is the biggest racket this country has going and its no wonder people seek help from other countries like Mexico. Best wishes on your journey.

[herewegoagain 15]

Congrats! Your persistence paid off and will help others in the future. I always hand delivered everything to my surgeon's office when I had my lapband in 2005. I always kept a copy. It was amazing how many times they told me they hadn't received what I had delivered. And, I hand delivered it!!! Anyway, now I am having to have the VSG due to a slippage and am currently doing all my pre op labs... x-ray, EKG, blood, stool, 24 hour urine, etc. I know it is a pain, but will be worth it. At least Kaiser has electronic medical records. Once again, congrats! Keep us posted after your surgery.

Joyce

[kiwi0615 0]

I have a surg date of 5/20 with still no approval from the bcbs nj insurance. I am getting pretty worried because i submitted my disability paperwork for work because it needed to be in 30 days before going out... I am hearing and reading some horror stories and starting to get discouraged....

[BABEwiththePOWER 16]

Thanks for your well wishes everyone! And Kiwi - keep your head up, and keep on top of your insurance. Don't let them screw around and waste your precious time - call them daily and keep a log of your conversations. It really is about the "squeaky wheel."

good luck!