Dont Know What To Do... (Cigna Oa Blues)

[littlemiss0428 30]

I didnt expect this "insurance game" to play out like this. Bear with me --this may be a little lengthy...

My first letter from Cigna (OA) was last week.. I posted my frustration, but felt as though things would get approved. This past monday I received an official denial. The letter stated that they needed the letter from another physician other than the surgeon. The problem is that my primary physician wrote a letter that included my weight, BMI, co-morbitities, and that I would be a good candidate for the surgery. this was included in my file. I spoke to my Pre-determination cordinator, and he didnt know why it was denied..... I called Cigna and asked them what were they looking for, and what is the next step.... Mind you, EVERYTHING ELSE is there. I thought perhaps my surgeons office did not fax the primary's MD's letter. They faxed a "reconsideration" letter yesterday, and it was denied today. Feeling very anxious, I called Cigna, and explained everything, and wanted to know if my letter from the primary was there. The rep from Cigna was very nice. She found the letter, but it wasnt worded specifically for Cigna. They want the wording to specifically say that I am healthy enough for surgery, and that I am medically clear from the primary's standpoint.

Ok.. so i called my primary's office, and now they are saying that the Dr may not clear me medically because I dont have a surgery date yet. I called the surgeons office AGAIN, and he said that he will schedule me a "dummy" date, and will fax the correct "verbiage" to the Primary... So now... we wait

Well... by the end of all of that, I could even concentrate at work.

I had so many feelings going on. I felt like the go-between with my surgeons office and Cigna.. I felt like my pre determination guy isnt working hard enough.. (He seems too nonchalant for me). Are these normal feelings for someone in this situation? Is there anything else I could do?

At first I thought of other routes (i.e Mexico) or giving up all together..I was really having a pity party BUT after I looked at other people who have done this, and who are living better, healthier lives, Im ready to fight again! I will not give up on the count of some technicality... Ive met all the qualifications for this, and Ive put so much of my time, and money into this. Ive worked really hard trying to get this together, So the Saga continues.... I will keep everyone posted....

p.s. I know I have some typos, but I cant find the spell check.. lol

[CIGNAQuestions 0]

HI, my name is Jason with Cigna Healthcare. I am truly sorry to hear about your frustrations.

I would like to offer you my help during this time. If there's anything I can do to ease your mind during this process, please Email me at LetUsHelpU@cigna.com. I will be more than happy to answer your questions and address any concerns you have.

I wish you the very best.

[Ready4success 380]

Sorry to hear about your denials, but hopefully the new letter will clear everything up for you. I am glad you posted what was required in the letter. I have Cigna (OAP) also, and I've been worried that my PCP wouldn't know what to write. I understand the letter needs to include:

1. Height, weight, BMI

2. Co-morbidities

3. Statement saying the surgery is medically necessary

4. Medical clearance that it's safe for me to have the surgery

Did I miss anything?

Thanks, your help is appreciated.

[littlemiss0428 30]

Yep... Thats pretty much what they wanted. My Surgeons office gave me a "template letter" to give to the primary doc, and the wording still wasnt what Cigna wanted. (Go figure). Thanks for the encouragement!! I will follow up with everything on Monday

[HopeThruFaith 30]

I had the worst time with Cigna. I went round and round with them for months. Just be persistent and don't give up. The same thing happened to me. My PCP had wrote a letter but they STILL asked for a letter from a doctor other than my surgeon. So, I scheduled an appointment with my PCP to get a "surgical clearance" which is just like a physical minus the female exam. She wrote me up as being cleared for surgery and I got my approval. The insurance companies are very meticulous about what they want but sometimes not so clear about what it is they want us to send. If you still get a denial I would try calling your PCP for that "surgical clearance" letter. I'll keep you in my thoughts...hope it works out.

[littlemiss0428 30]

Thank you so much!! I mean... I get it.... Cigna is going to make sure every "T" is crossed, and every "I" dotted.... I just pray that everything works out, and that I get this done soooooon (lol)

[Ready4success 380]

Yep... Thats pretty much what they wanted. My Surgeons office gave me a "template letter" to give to the primary doc, and the wording still wasnt what Cigna wanted. (Go figure). Thanks for the encouragement!! I will follow up with everything on Monday

Thanks for the help, and GOOD LUCK!