Waiting For Approval! Cigna Help! (Nalc,feds)

[kadive 21]

Hey all!!!

My surgeons office submitted my info im thinking either last thursday or friday.

Im just wondering how long it usually takes??? i've heard of people hearing back really soon like in a few days... im just REALLY anxious for a yes or a no... i want this so bad and the waiting seems like eternity!!!!

Does anyone have cigna (NALC) federal insurance??? or cigna in general? i just wanna know how long it took for you to hear back from them??

Patiently waiting

Krysti.

30 days and they are very very tricky. Two denials and lots of calls.

Good luck!!

[noonie 0]

Keep in mind, anyone reading this, that NALC is an additional layer of bureaucracy on top of the cigna policy #0051. I found out from NALC that, according to them, they can do what they want, and what they choose to do is IGNORE evidence of universally-accepted co-morbidities, including ones recognized by their underwriter, Cigna (hypertension of over 140/90 despite medication--with letters from 2 primary care physicians spanning a period of 6 years).

Yes, you can waste months on appealing and ultimately suing OPM (which you will win, if it's a case of "arbitrary and capricious denial".. see case Dunn vs. OPM re: NALC denial of surgery). But since open season goes until Dec. 10, I recommend anyone trying to get approved via NALC jump ship to a plan that specifically recognizes co morbidities and doesn't add words like "serious" and other limiters. Oh I am certainly encouraging those who do change, to still appeal in the meantime.

[slimmerplt 7]

I have CIGNA Open Access Plus which is associated with CIGNA Great West which is on the back of the card. My package was submitted on 26 November and denied today! Yes i'm devastated but they havent heard the last from me. They didnt accept my Weight Watchers because it wasnt physician supervised. So i'm participating in a 3 month disciplinary program at my surgeon's office. I hope that flys. But i called CIGNA today to ensure there was nothing else and they said they need a letter from a doctor other then the surgeon recommending surgery. Not understanding this because a letter from my PCP should have been sent and it clearly states she recommends it. Oh well I actually originally started the 3 month program last month so i will be finish middle of January. Just worried that my insurance may change!!

Good luck!

[noonie 0]

well, keep in mind thomasplt that NALC is NOT Cigna, but a union run insurance underwritten by Cigna.. Cigna has policy 0051 that is pretty liberal compared to NALC who adds criteria.

I hope those Federal employees read my post and opted out of NALC... let them die the natural death they so well deserve. I am going to appeal.. their second rejection letter rejects pretty much anything that CIGNA recognizes as a comorbidity. Use the words "arbitrary and capricious" in your appeal letter, because that legalese will carry forward. NALC is poised to reject everyone because let's face it.. the postal service is in dire straits. Their union is worthless.. and any union that would tighten criteria is NOT worthy of dues.. (POSTAL EMPLOYEES>> TAKE NOTE) Too bad the cowards don't put a name to the denial letters because I want names for my attorney to individually sue. I am a union representative of another agency..but I would implore NALC members to FLEE from these crooks and defect to another postal employee union.

[noonie 0]

ok.. so I am angry.. but they actually claim they reject me because 1. I dipped below 35 BMI in January 2012 because I was doing their mandated weight loss program and 2. I am on bp medicine. NEVER mind the BP medicine can't lower my bp below 140/90.. Cigna's threshold. and also they consider snoring not apnea.. and ignored a whole host of comorbidities including knee problems, fatty liver, and ateriovenous malformation in the brain that can't handle elevated cranial hypertension. .. oh, and arrythmia treated partially with ablation.

[slimmerplt 7]

@noonie thanks for ur reply n I information. I do bot work for the postal service but a government contractor. I'm sure that doesn't matter much. I got my denial letter which states that medically necessary was not meant because of the three month supervised program and they provided what needed to be in the notes and also a separate medical evaluation from another doctor recommending surgery and states it is medically necessary. So I will submit again n mid January and if dwindling I will take action.

[barbi1281 112]

I have Cigna and they're pretty quick but they're also pretty quick to claim they didn't get something even though they did. If they deny you and you know you should have been approved or they say they didn't get something STAY ON THEM! I called multiple times a day and that was the only reason I had my approval in a timely manner (meaning 2 denials and nearly 2 and a half weeks after first submission). My surgeon said Cigna is one of the worst to deal with and it would have taken way longer if I wouldn't have been such a thorn. Just don't let them get you down or make you give up no matter what...

[noonie 0]

@barbi, NALC is underwritten by Cigna. My information hasn't even made it to Cigna because it was NALC, not Cigna, that shot it down. NALC explains that they only forward cases to Cigna once it passes their own internal precertification.. so in essence, the federal postal unions play the middleman. Cigna policy 0051 clearly states my comorbidities qualify. NALC reports they don't recognize and don't have to recognize those. NALC apparently only recognizes immediate life-threatening comorbidities such as "severe diabetes" or "severe cariopulmonary disease." Apparently they believe there is such a thing as "mild diabetes." So I guess unless one has had a heart attack or had limbs amputated, one will have to sue NALC/OPM to even get their paperwork through them to Cigna.

[barbi1281 112]

@Noonie - have you done a sleep study? Even though my asthma was so severe it was deadly, it didn't qualify - nor did my other lengthy list of comorbidities but I was an evil snorer and my doc sent me for a sleep study... just so happened I had sleep apnea after all and never knew. Either way, keep fighting. I was at the point of suing for bad faith denial... to me this was life or death.

[noonie 0]

I'm working on getting a sleep study.. my primary offered to order one back in Sept. My new insurance takes effect Jan 13. I have decided though, to switch to RNY bypass because of my sweet tooth (yay dumping syndrome) and the fact I already have a problem with acid indigestion. Also, my insulin resistance could be better served by RNY. I figure this is a one shot deal.

[noonie 0]

So we kicked NALC to the curb and signed up with BCBS Federal during open season. BCBS took effect 1/13, and my surgeon's office faxed over my file/request on 1/14. I got approval on 1/22 and surgery is 1/29!!!!

Anyone reading this who has NALC and BMI < 40.... if you are stuck with them, appeal, appeal appeal! If it's open season, bail to another company in the FEHB program!

[paleal1107 14]

I'm waiting for Cigna to approve mine as well. I'm just anxious to get the rest of my life started. I'm so tired of the needs and being a diabetic. Good luck.