Denied Because Hospital Didn't Renew Contract >:(

[vdunn87 2]

I was denied by cigna because the Memorial hermann hospital I chose didn't renew their contract to be a Bariatric center of excellence. How dumb is that? Then I'm told anyone who applys in the houston area through cigna will get denied if they dont go to two hospitals in northwest houston. There is a huge selection of surgeons in houston that accept cigna. To me this doesnt make sense. Then conveniently one would think the surgeons office had prepared for something like this but no. Okay so then I called all the doctors that work at the two hospitals mentioned. None of those doctors have openings till sept/oct. I know there are going to be road blocks but I can honestly say the last few days I was being positive till this came up. I really feel like after a total of 2.5yrs trying to get this done, I want to give up. The average person will have "road blocks" I'm sure but not this many.

*then i get a call from the surgeons office saying it was a misunderstanding and they will correct it and submit for reconsideration. I'm so confused. I hate cigna

[mufasas-mom 170]

so sorry - I hear that Cigna is one of the harder insurance companies to deal with. Are you very far away from the other two hospitals? I hope you get a date soon, this must be very frustrating for you.

[vdunn87 2]

I'm about an hour or more away from the other hospitals. But the coordinater said M.Hermann is correcting the mistake and that it will take a few days then she will resubmitt. I just dont see why it should be so hard. Cigna would save tons on medical expenses if obese people were not red flagged on the surgery process. They have to pay so much more for us if we remain obese.

[isajck 229]

Just relax, it was a mistake per the surgeon's office and is being corrected. Sounds like you are getting worked over nothing. (I know the only covering two hospital in Houston is incorrect b/c a friend is in with Cigna and in her six month pre-op program with a different hospital).

[Ready4success 380]

I have Cigna and I'm having my surgery at Park Plaza. I actually wanted to go to Hermann, since I used to work there, but my surgeon said no.

[MJ's comingN2form 103]

I don't see why u will be denied becuz of a non par hosp. I was going to have mine @bayshore in

Pasadena when my paper work was submitted to my carrier by Nuweigh but I changed hosp at the last minute to a non par hospital (university general) I was still approved but they (the hosp) honor in network benefits because I was a nuweigh patient

[vdunn87 2]

I had spoke with the insurance company and their the ones who told me why I was denied. I specifically asked them "there are alot of people covered by cigna and alot of surgeons that accept cigna, are you telling me their all going to be denied based on the hospital their going to?" the guy said yes. Also as far as Memorial hermann, I contacted the doctors office who had to contact the hospital to correct the mistake. Despite everything else being the surgeons office' mistake, this was actually out of their controll. I however don't approve of how they handled it. This happened on Tuesday. I called her and she told me it should be fixed in a few days. I called back Wednesday and she gave me a surgery date then told me it was going to be fixed the next day. I called Thursday and she basically stated the only reason she gave me a surgery date was to make me feel "comfortable" with how long it was taking. In other words to shut me up. Being that its almost a week since I was denied I'm alot calmer than I was. At this point I dont expect anything and take what I can get. The mistake has not been corrected even though it should have been. Btw if any doctors office ever tells you they cannot release any part of your medical records because of HIPPA this is a lie. The only way they can refuse to release your records to you is if it poses a threat to you or someone around you. Unfortunetly I'm on a roll at the moment so while I'm not freaking out I still intend to call her every day untill I get resubmitted.

[xavtay2 85]

Hello VDunn! I just experienced the same thing with Cigna the beginning of June. The part that was so frustrating to me was the fact that I did not hear anything about this part of the policy until my paperwork was submitted and denied. I took 3 routes: contacted my hr advocate, contacted state insurance to file a compliant and I wrote a letter of appeal. One by one I was told to just find another doctor that works at a Cigna certified center of excellence! Finally after about a month I received a call from Cigna stating I was approved! I was frustrated and annoyed but now I know that everything happened for a reason! Did I mention all of this was while I was pursuing the Lapband! So glad it happened because now I am going with the sleeve! Good luck don't give up and call them everyday if you feel you need to! Blann

[vdunn87 2]

thanks for the input. Actually yesterday I signed up with a different surgeon. The Lady at Dr. Ferrari's office (Lara) was always lying to me and losing my paperwork. At one point she told me my medical records weren't good because they didnt have my weight recorded. I in turn went to the original doctors office and got a copy. Sat at home and went through it all to find my weight was recorded 24 times. Before doing such a drastic decision I did call Dr. Ferrari's office to ask Lara what the status was. She of course lied again and said the hospital corrected the status and I needed to call my insurance to expedite the response. I called and Cigna had no record of anything being corrected and nothing submitted. I know sometimes it takes a few days to show submitted paperwork however I was done with the lies Lara continued to tell me. She wasn't even an actual patient co-ordinator. She is also a secretary and Medical assistant. Then I go to this new doctor Ata Ahmad''s office to fill out a release form to request my records. They have an actual Patient Co-ordinator who was completely willing to help me with everything. She went over alot of information Lara never went over with me. I haven't had the consult yet but I'm already feeling 100 times more positive about this new surgeon than I was about dealing with Lara. Its a shame too because I really wanted to go through Dr. Ferrari. Lara ruined my experience and caused her doctor to lose a patient. I would never recommend anyone going through them unless Lara is fired. I'm already more than 3 months behind because of her uncoordinated irresponsibility.