Cigna - Denied

[Radwilk 4]

Today while recovering from my upper GI I received a call from the insurance coordinator at my surgeon's office. She informed me that I had been denied for my surgery next Tuesday due to the fact that the surgery was taking place at a hospital that is not a bariatric center of excellence. From the beginning of this insurance process in January I have communicated with CIGNA several times regarding my surgery and the steps I had to take for approval and NEVER has this been mentioned as a requirement. The coordinator has spoken to CIGNA several times regarding the criteria and CIGNA did not inform them that I had to have the surgery at a BCE. Aside from the problem that I really like my surgeon and have been with him and his staff since February there are no BCE within 200 miles of my home. Even when I called the preauth dept, benefits dept, and a few other departments at CIGNA today not once did I get the same answer about where I could have my surgery. I am so devestated. I don't really know if anyone has had this same experience, but if you have please let me know. I would like to appeal, but I want to make sure I do it right.

[gloriann 43]

Hi Radwilk,

I too have Cigna and was denied due to the hospital my dr was at was not covered under the plan. The letter i received also stated that the surgery wasn't covered. After a little research, the codes that were sent in weren't the correct ones. I hope this gets worked for you. Sending prayers your way. Good luck!

[Izuri 428]

I would contact CIGNA and get a list of what they require for an appeal. I would record that, with the name of the rep and the date. Then I would gather that all in and send it. Try as hard as you can to find the dates/times you and the bariatric clinic called so that you can reference specific conversations (if you have rep names, all the better) where you asked about requirements and that was never brought up. Hopefully that will help you!

[Mensch 150]

Don't give up!!

[mufasas-mom 170]

Most plans want you to have any bariatric procedure at a center of excellence, that being said - many will pay up to $10,000 (according to my policy) for travel and accommodation for such a surgery. You may want to check into that option.

I have UHC and had to change surgeons because my first surgeon was NOT affiliated with a COE and there was no way I was trying to get this done without insurance - so new surgeon and correct hospital = no pay for me!

[Radwilk 4]

I spoke to the head of HR for my company and she contacted CIGNA on my behalf. Apparently I am not the only one with this problem right now. CIGNA acknowledged that they are failing to notify patients or doctor's of their requirement that the surgery must be done at a CIGNA approved COE. In the denial letter it says denied due to the fact that hospital X is not a Bariatric Surgery Center of Excellence. When in fact my hospital IS a COE just not a "CIGNA" COE. Even the denial letter is not specific enough to say that they don't just mean a COE but a "CIGNA" COE which there are none within 200 miles. Today when I called CIGNA to ask where I could have my surgery they gave me the wrong information yet again and told me my hospital is on the list of acceptable facilities. This is not my mistake it is CIGNA's and I don't understand what else I could have done to make sure I was seeking services from a surgeon affiliated with a hospital that they approve of. Ultimately I just want to have the procedure I need, but I am terribly uncomfortable driving 4 hours away and not receiving the follow up care that I need. If I were to have surgery in Houston and be discharged home and had a complication at home I could not call my doctor and have him meet me in the local ER. That is a huge risk that CIGNA is forcing me to take.

I am so frustrated, but I am not giving up. I am considering having a bariatric advocate handle the appeal for me. Has anyone ever done anything like that? What can I expect?

[xavtay2 85]

Today while recovering from my upper GI I received a call from the insurance coordinator at my surgeon's office. She informed me that I had been denied for my surgery next Tuesday due to the fact that the surgery was taking place at a hospital that is not a bariatric center of excellence. From the beginning of this insurance process in January I have communicated with CIGNA several times regarding my surgery and the steps I had to take for approval and NEVER has this been mentioned as a requirement. The coordinator has spoken to CIGNA several times regarding the criteria and CIGNA did not inform them that I had to have the surgery at a BCE. Aside from the problem that I really like my surgeon and have been with him and his staff since February there are no BCE within 200 miles of my home. Even when I called the preauth dept' date=' benefits dept, and a few other departments at CIGNA today not once did I get the same answer about where I could have my surgery. I am so devestated. I don't really know if anyone has had this same experience, but if you have please let me know. I would like to appeal, but I want to make sure I do it right.[/quote']

Hello everyone I just experienced the same exact thing with Cigna! No mentioned of this requirement was ever mentioned during my year process. I have an attorney in my family and she helped me put together my formal letter of appeal. It took a month but a Cigna representative that works specifically with bariatric patients called me to let me know I was approved and the funny part is they have now approved me for any hospital that I wanted to use! Moral of the story don't give up! Write a letter of appeal, state the facts, don't be repetitive and state dates and times of your contact with Cigna representatives.... The most frustrating part was I got a different answer everytime I called.

I ended up choosing a Dr that works out of a COE hospital! Everything happens for a reason because now I couldn't be happier. Write the letter of appeal! You have nothing to lose

Blannie