Denied

[Odee 57]

So I just found out that Cigna denied my claim. My coordinator said we'll just try again after resubmitting. I feel like I was kicked in the stomach !

They said the PCP letter and co-morbidity were missing and the consultation with the nutritionalist. The PCP letter and co-morbidity information was not omitted so I am not sure why they are claiming that in the denial. The consultation with the nutritionalist was missing however. I have that appointment tomorrow at 11 AM. The coordinator said she's been super busy and didn't realize I hadn't had the consultation yet and apologized. Why would Cigna claim to not have received the letters ? Just frustrating to get this far and then get denied so quickly.

Just wanted to vent ! Thanks for listening !

Odee

[KristinaRN 54]

Same thing happened to me, something they claimed was missing was in fact there; my insurance coordinator from the surgeon's office called them and it was straightened out later that same day. Good luck!

[traceylynn 33]

Hey girl,don't get discouraged!i have Cigna and they have been nothing but difficult.they said I missed a couple of weigh ins and tried to deny me but I faught it!i hear a lot of stories of Cigna being a pain in the ass but I hear of a lot of people appealing the denial and then getting approved.you got this!!

[Wheetsin 714]

CIGNA denied me the first time. The two things they said I was missing were things that are kind of impossible to prove, beyond the proof we'd already given them. So I ignored one of their denial points, and went to hell & back writing up/documenting proof of the second (it was the harder of the two to prove).

They eventually approved me, just as our coverage was switching, so I got to start over.

Make it as clear & concise as possible when you re-submit. Here's what I would do (I worked in the insurance industry for years, and still do private consulting for a few companies). Next to each of their denial bullets (or however they formatted it) write in "see attachment page X", where X is the respective page that you're sending them. Then number everything you're sending. And at the top of each page, add in a note stating something like, "For consideration for the requirement of list requirement:" so they doubley sure know what the exact relationship is between what they're seeing and what you have to prove.

This will give them a sort of quick reference "table of contents". They're not going to read big long letters, they're going to scan in effort to mark off a checklist. The easier you can make it for them to find what they need, the better your changes of winning the appeal.

Just my $0.02.

So I just found out that Cigna denied my claim. My coordinator said we'll just try again after resubmitting. I feel like I was kicked in the stomach !

They said the PCP letter and co-morbidity were missing and the consultation with the nutritionalist. The PCP letter and co-morbidity information was not omitted so I am not sure why they are claiming that in the denial. The consultation with the nutritionalist was missing however. I have that appointment tomorrow at 11 AM. The coordinator said she's been super busy and didn't realize I hadn't had the consultation yet and apologized. Why would Cigna claim to not have received the letters ? Just frustrating to get this far and then get denied so quickly.

Just wanted to vent ! Thanks for listening !

Odee

[phatmom 1]

I have Cigna insurance too. They denied me also (3 times) I went back to my PCP and he retyped the letter to include the terms Medical clearnance and he recommended me having the surgery. The coordinator with my Dr. office was very helpful in getting everything they needed. My husband is also planning on having the surgery and he was approved - and his letter didn't include any of it. You will just have to "do the insurance dance" and have patience - I am finally approved and have a surgery date of July 31, 2012... Keep the faith and don't give up!

[innerme 26]

I know it's hard but don't get discouraged. Same thing happened to me as well with Cigna. I got a denial 3 days after submission saying I was missing physician's recommendation as well as 6 months of diet. They recvd both - in fact they recvd my entire patient file for each individual month and a letter was also enclosed my dr had written why I needed to have this done. My case worker was totally baffled but told me it happens more than it doesnt and that with the denial the next step wd be to appeal which they immediately did and had a peer to peer with Cigna's dr. They requested to have the information placed on one page instead of reviewing each months of weigh ins's and dr notes on 6 different pages. My Dr also had to write a one liner saying I was all clear for surgery. Once my case worker sent it back that way they approved 2 weeks later. I think this is probably one way that Cigna tries to allow themselves more time in reviewing the case because once they deny they automatically have additional time to work thru their process. If you have a case worker that works for your dr they should be handling all this for you.Also don't expect to get any information from Cigna that is correct once it's denied because the notes are not updated so customer service can see once it is being reviewed by Cigna's advocate who is assigned for the peer to peer. I learned this the hardway and with much frustration when I tried to get info after everything was resubmitted and kept being given inaccurate info. As this was happening I heard from my caseworker that I had been approved but they were waiting on the info in writing before they proceeded and had Known for a week but at the same time Cigna was telling me they were showing in their notes they were waiting on a peer to peer to be done with my dr.