Letter from Cigna... not denied yet

[ArcusX 216]

After having been submitted to insurance on 12/19, I received this in the mail over the weekend:

Dear DOUGLAS KRAHN, MD:

We received a request from you on 01/08/2013 for JOHN for coverage of the following

service(s):

• Laparoscopic Gastric Bypass (43644)

After review of the information submitted, we are unable to substantiate medical necessity for the

requested service(s). To process your request, we need the following additional information:

• Fax any pertinent clinical information supporting the medical necessity of the services

requested to 1-800-558-3710. Please refer to CIGNA's Coverage Positions at www.CIGNA.com.

Please be aware this is not a denial. Once clinical

Fun...

[geno5150 168]

I would call CIGNA myself and ask them what information they currently have and what specifically is missing. Then I would call the doctor and relay that same information, then calling CIGNA every day and checking to see they have received it, then following up with the doctor to find out why it has not been sent.

At lest you don't need to go the appeals route yet- that's a plus in your favor.

[MOMW 71]

Good luck. The insurance is probably the most frustrating parts for those of us who are lucky enough to have insurance cover it. To ease your mind, call your Bariatric Team and make sure they got the letter and that they will be responding promptly. They are pulling for you, and want to see you suceed too.

[banditchic 83]

I was actually denied by Cigna at first. They requested more documentation. I just had my dr write another letter explaining how this surgery would help. I was approved 2 days later. Cigna wants to see if you are willing to fight for it. Stay strong and keep fighting!

[ArcusX 216]

Yeah, I had forwarded a scanned copy of the letter to the insurance coordinator on Saturday, asking her to call me when she was available. She called yesterday afternoon, and we discussed briefly. She told me that they had submitted all of that, but would call and get to the bottom of it. I'll call her back later today to see what happened.

At this point, I think they're just delaying. We'll see.

[MOMW 71]

Keep up the deligence. The prize is worth it and so are you. Hope your weight is short.

[geno5150 168]

Yeah, I had forwarded a scanned copy of the letter to the insurance coordinator on Saturday, asking her to call me when she was available. She called yesterday afternoon, and we discussed briefly. She told me that they had submitted all of that, but would call and get to the bottom of it. I'll call her back later today to see what happened.

At this point, I think they're just delaying. We'll see.

My insurance coordinatior told me the same thing, but in reality had not sent all the paperwork over. She was also wrong about the insurance company requirements- they deal with many different companies and sets of requirements, so mistakes happen way more than you think.

I would highly suggest calling CIGNA yourself and double checking because you have no idea what they have received from your doctor or what may be missing. You are always your own best advocate.