Delay But Not A Denial

[littlemiss0428 30]

Ok... Trying not to scream...Breathe...

Ive submitted ALL my paperwork to the insurance company on 5/30/12. I was surprised when I received a letter TODAY from Cigna. My smile quickly turned into a WTH(heck) when I read that they unable to authorize my request for the procedure until they receive "additional" clinical paperwork... What additional clinical paperwork?? I've had 6 months of diet/ excercise signed off by ARNP, psych eval, upper GI, gallbladder ultrasound, MD visit, and Nutritional eval. I was soooo hoping to get this done sometime in June, because I begin nursing core classes in July. At the bottom of the "Delay" letter it states:

"Please be aware this is not a denial. Once clinical information is received from the provider we will make a medical necessity on decision on your case" .....what???

My Surgery Coordinator will definitely hear from me first thing in the morning, but until then Im pissed!!

Any encouragement is greatly appreciated...

[welittle1 26]

Ah the red tape! I'm sure everything will be fine, keep your head up. I go for my psych eval tomorrow, a bit nervous but will be glad to get it over with then I can schedule my surgery. Let us know what happens please.

[BentleyJade 28]

I have BCBS Nebraska, and I got a similar paper stating they are requesting more paperwork/certification type stuff..so I called my nurse and she said not to worry. They basically send the same thing to the drs office, and the drs office is responsible for everything. So that's what happened with mine..hopefully they will tell you the same thing!

[littlemiss0428 30]

Thanks ladies... I really appreciate the feedback. Ive decided to have WLS in August 2011. I originally decided on the Lapband, but decided about 6 weeks ago on the Sleeve.I beleive this is the best decision for me. I will keep you guys updated on my status...

[welittle1 26]

BentleyJade, I hope your bcbs will cover your surgery, I have bcbs of kansas and they won't cover any type of wls so I'm self pay. Good luck to you!

[BentleyJade 28]

Welittle1- I'm definitely hoping they will cover it! I have insurance through my employer and I work with a lot of people who have had it already, even used the same surgeon. So maybe it all varies state by state. I spoke with my insurance company today and they said I should know something by next week! Fingers crossed!!