I Am Beyond Frustrated!

[innerme 26]

I have spent the last 7 mths jumping thru the insurance hoops making sure every little detail was taken care of and not leaving anything to chance when it comes to 6 mth diet, test, psych eval, 5 years of medical history not just 2 and every other detail the insurance requires. I fit the requirements of my insurance requirements for my bmi having type II diabetes, gerd, high cholesterol, having issues with my joints due to my weight to the point I have had to have foot surgery, etc....My surgeons office submitted the paperwork and Cigna sent a denial as they sd it was missing 2 pieces of information, which by the way was submitted. My surgeons office immediately following protocol scheduled a face to face with Cigna. My case worker stated to me the denial happens alot more than not and they know that more than the required information was submitted. Last Thursday my surgeon and case worker had a face to face meeting with Cigna as they were being told they needed 2 more things for the approval 1) a statement saying I was cleared for the surgery from my primary physician even though my physician had put in a referral as well already wrote a long letter explaining the benefits this surgery wd have on me, and 2) they preferred not seeing each months doctors notes from the file for my 6 mth diet/exercise program they wanted it submitted on a seperate form -REALLY? My Case worker told me it was the first time they experienced this and was blown away because they knew everything was sitting there in black and white. Ok so my doctor takes care of these two pieces of information and my surgeons office submits it. So today I called Cigna to see if they have received the information and if they have reviewed it yet and they come back and say they have requested a face to face meeting with my primary physician to discuss medical necessity! Has anyone ever heard of this, or has this happened to you? What was the outcome? I'm getting extremly annoyed at this point!

[Giselle3264 175]

Hopefully some of the Cigna folks will see this and jump in. I've not had any exposure myself or here in the forum to something like this. I hope they turn all this around SOON!

G.

[msYoYo 17]

Which state are you in? I have a little experience with Cigna, I've never heard of the face to face meeting. That's new to me.

[100%Sleeved 148]

Wow I've never heard of this. I pray all goes well with you.

[innerme 26]

I am in Florida. I called Cigna again yesterday and spk to someone else and they sd it's not a face to face meeting they need a Peer to peer meeting. I spk with my coordinator again and she sd she is totally blown away with this but they are checking with Cigna again. She shared with me that one of the patients had did a 6 mth diet thru weight watchers which was clearly stated as a acceptable diet but when the paperwork was submitted the insurance came back that they werent going to accept weight watchers and she needed to do another 6 months. I think insurance companies are trying to find more ways to reject people since more people are deciding to go this route. I'm just biding my time now and waiting to see what happens.