Beyond Upset

[Pumpkinmeli 15]

I just got off the phone with Cigna. The medical director denied my application for bariatric surgery. They wont tell me why I was denied. I then called my doctors office in tears and the receptionist tells me that they are seeing patients and cant help me until tomorrow. I am 16 days from my surgery and no one at my docotrs office and help me until tomorrow?! On top of that I dont even know why I was denied so I dont know what I need to do to get it approved. I am sitting at my desk in tears. I have gone through 6 months of clearances and spent a small fortune on getting everything done for approval. I have been on a liquid only diet for 2 weeks and now the fate of my surgery is in the air. I dont know what to do... im heart broken. :-(

[scorpion509 107]

Hold on.... I am sure the Doctor office can do the appeal. Can you call insurance yourself and ask why you were denied?

[Pumpkinmeli 15]

I talked to the insurance and they told me I need to talk to my doctors office for the reason of denial. I work in HR so I just talked to my boss who is in benefits and they are going to contact our rep to see if we can get more information. Either way I am worried that the appeal isnt going to get done in time for my Sept 20th surgery date. It took them 2 weeks just to review what we sent in. Apparently Cigna sent me a letter explaining why I was denied but I wont get it for 10 days. I guess they dont let the reps tell me over the phone....

[IsB 209]

That's really outrageous that they will tell the doctor's office but the patient has to wait for a letter to be mailed. The only other thing I would try is to see if a copy of that letter is available online. My insurance company, Oxford/UHC, makes a lot information available online. Try going to your Cigna webpage and see if a copy is in the online mailbox.

If that doesn't work, stay calm and speak with your doctor tomorrow. I imagine it's frustrating but it's not time to panic. They probably just lost something and rejected instead of asking for it. Wait and see what the doctor says before you drive yourself crazy. Good luck

[mzblacque 11]

I am sorry that this has happened to you. I work for an insurance company and I often see wls denied due to the doctors not submitting all of the necessary documentation to support the need for wls such as co-morbitities, psyche eval, smoking history and substance abuse history. I can be as simple as the office needing to send additional documentation. There is still hope to achieve approval prior to surgery so please dont give up. My prayers are with you that everything will work out. If your insurance covers wls, and you know you have met the requirements, then I DO believe everything will work out. My prayers are with you.

[Pumpkinmeli 15]

Thanks everyone... I will hold tight and wait to hear from my doctors office. I was reading through the forum and see I am not the only one going through this. Its hard when I have spent so much time and money getting through the steps Cigna requires only to get hit with a denial. Especially this close to my surgery date and having been on a liquid diet for 2 weeks already I felt like I did everything for nothing. I hope its an easy fix and that my doctors office will be able to appeal this and get it approved in time for my pre-op appointments. I have a feeling at this rate its all going to be VERY rushed. Thanks again everyone!

[FDclerical 318]

awww im so sorry!!!! thats so odd because my surgeons office doesnt schedule a surgery date UNTIL you are approved! why would they set you up and not know the final outcome??? i hope all goes well for you and i pray for the best!!!!! good luck

[Pumpkinmeli 15]

They have to have a surgery date on the paperwork when they submit it to insurance. They picked a day 30 days in advance since Cigna is only supposed to take 2 weeks to get back to me. I have to be on the pre-op diet (liquid only) for a whole month prior to surgery so everything fits together. Just from reading everyones topics under the Insurance forum I think its ridiculous that we have to go through these denials and the appeals. We all work SO hard to do EXACTLY what these insurance copanies ask for. I even had my local rep give me the outline for bariatric surgery covered under my policy so I could follow it to a T. Then when I met with my doctor I was given additional requirments for clearance for surgery to complete. As mentioned I spent a good part of this year completing all of the required steps from Cigna and my doctor. To get a denail this close to surgery is just wrong... if they are missing something or need more information... why not tell me on the phone so I can do something about it. Instead they try to make me wait 10 days to get a letter in the mail!? Thats just crazy. I deserve the right to know why I was not approved just as much as my doctor has the right to know. Its almost as if they want me to just give up because they dont want to pay for it. Except my life depends on this surgery and I need it... So... Im not giving up... I will fight until I get what I want.

[barbi1281 112]

I'm so sorry :-( This scares me as I have Cigna and my biggest fear is what you're going through. I will keep you in my prayers and please keep us updated. Hopefully it's something small that can be fixed quickly.

[joyful noise 101]

The first letter from Cigna did not say I was denied, but that something was missing from stuff submitted. I called the surgeon's office and the coordinator told me that was standard procedure; more like an automated letter. When I did get a letter of approval, it said for Sept.21. Again, I called the office and she said they have to give Cigna a ball park figure of when it will be done.

Since I have to see a Pulmonologist (tomorrow) and the Cardiologist on the 17th, only God knows when my surgery will be.

Since they only do sleeves on Fridays, and my surgeon teaches the procedures world wide...I am in limbo right now. I was getting upset and decided it is "in His time" (God's) and am keeping busy to not think about it.

I am praying for your approval. The surgeon's office usually handles the rejections to get them approved. So, don't worry.

[Ready4success 380]

Sorry to hear about the denial, but it if you meet the BMI requirement, or have co-morbidities, you'll get approved. These are just bumps in the road. If you have a copy of your letter from your PCP, see if it has these 2 things specifically that have gotten people denied:

1. Medical necessity: The operation is medically necessary to improve your co-morbidities (list co-morbidities)

2. Medical clearance: You have to go in for an appointment with your PCP for the clearance letter. It must read that you were examined on that day and you were found to be cleared from a medical standpoint for surgery.

They wanted an actual progress note from my PCP's office showing that I went in to be examined, and didn't just pick the letter up. I know it's unfair to have to play by their rules, but just keep your spirits up, and you'll get the approval and the surgery. Good Luck!

[mysunflower621 69]

I have had the same issues with Cigna. I was first going to get the lapband and they denied me 3x saying paperwork was missing and the 2nd denial they wanted info they never requested before and wasn't on their requirements. WIth the 3rd (and so called FINAL appeal) they have a 3rd party vendor look at the info and I was scheduled for a teleconference for the appeal. The day before, the 3rd party vendor told Cigna they were crazy to ever deny me because I've met all the criteria and approved me with out the appeal. NOW, my doctor and I decided the sleeve was a better option for me so they called CIGNA to change the code since the requirements are the same and what did they tell the doctor? That I have to go through a whole new approval process and they have to re-submit ALL the paperwork they already have with the new code! Now I mean come on, does that make a bit of sense? They have everything, the requirements are the same and I've been approved for band, what's the big deal switching the code to sleeve? That's CIGNA for you... I hate them! SO .. now, I wait.... again...I feel your pain in dealing with them!

Good luck, hopefully it's something you can get fixed quickly!

[sramos89 260]

I am hoping it is not a denial, just they need more info, When BCBS needed more info, it came across as a denial. If you meet their standards, which you must or you wouldn't have done the 6 month diet and doc wouldn't have set the date, then hold strong! They will clear it up!!! I am like you and have my heart set on this, anything that gets in my way will break my heart. I am thinking about you. Please keep us updated!

[Berri 1]

Hello did you get your surgery?

[carlasuki 17]

Yes, please let us know what the out come was.