Denied Again

[Odee 57]

So, Cigna is claiming they still need a letter from my doctor that says I am CLEAR for surgery. My doctor has sent over 3 letters that all say variations of this yet they are not accepting the letters. Now Cigna says there has to be a peer to peer consultation. My surgeon's coordinator said she doubts the surgeon will do it and we'll have to appeal.

Anyone have to have this peer to peer and why would the surgeon not do it. She made it seem like he doesn't have the time.

Again, very disappointed especially since I did complete all the requested requirements. Cigna is definitely playing games and it is very frustrating !

Thanks for letting me vent !

Odee

[TaiDyed 59]

I wish I had answers for you. I can't imagine the frustration you are feeling. It shouldn't have to be such a difficult process, but as we often read from so many other posts, getting approval can be a challenge. Vent away and I hope someone is able to add a comment or two that might help you with an inside perspective. Good luck.

[Nikki613 120]

I am so sorry! I know your frustration. I had a very hard time with Cigna. I was denied once for the same thing (needing a recoomendation/clerance from a different Doctor besides surgeon). It was submitted twice and finally went through. My coordinator says Cigna is the worst to deal with and they like to take their whole 30 days. Im praying for you to have approval soon!!!

[IwantTHATshu 5]

<p style="text-align: left; ">HI! i am so glad I found this. I had to go through a VERY similar ordeal with Cigna the DAY BEFORE surgery. I was told I was denied less then 24hrs before my surgery. So I called up and they told me I was missing that letter from my surgeon and a letter from my primary care doctor. The letter from my surgeon was a mistake on their office...</p>

<p style="text-align: left; "> </p>

<p style="text-align: left; ">as for the primary care doctor letter, we had him write a few and none were correct. Finally the medical director at Cigna told us that the letter specifically needs to state "___ is my patient, she has (the following co-morbidities ) and 'based on my decision this patient is medically cleared for surgery'...."</p>

<p style="text-align: left; "> </p>

<p style="text-align: left; ">again this is for what worked for us! I am hoping this will work for you. Also make sure that your psychological evaluation is as up to date as Cigna wants it to be. (we were told that it needed to be within 6 months before surgery and of course mine was 8 months...) </p>

<p style="text-align: left; "> </p>

<p style="text-align: left; ">good luck! </p>

[neek41 34]

I'm so sorry. I can't even imagine what you must be going through. I say all things happen for a reason. I will pray that you get approved quick. Put this in God's hands and pray this is his Will that your surgery happens quick :-)

neek41

[IwantTHATshu 5]

HI! i am so glad I found this. I had to go through a VERY similar ordeal with Cigna the DAY BEFORE surgery. I was told I was denied less then 24hrs before my surgery. So I called up and they told me I was missing that letter from my surgeon and a letter from my primary care doctor. The letter from my surgeon was a mistake on their office…

as for the primary care doctor letter, we had him write a few and none were correct. Finally the medical director at Cigna told us that the letter specifically needs to state “__ is my patient, she has (the following co-morbidities) and based on my decision this patient is medically cleared for surgery…”

again this is for what worked for us! I am hoping this will work for you. Also make sure that your psychological evaluation is as up to date as Cigna wants it to be. (we were told that it needed to be within 6 months before surgery and of course mine was 8 months.

Good luck!!

[IwantTHATshu 5]

ALSO....cigna told US that the peer to peer does NOT have to be with the surgeon himself, but could be someone in his office like a nurse or for us we had the office manager talk to someone at cigna....

(sorry for posting so many times!)

[Odee 57]

Thank you all for your support and kind words. I can't say thank you enough! I was really feeling down. I know more than I did a few hours ago and feel optimistic. Feeling much better ! =)

Thanks Ladies!