Why would Cigna deny me?

[overdue 5]

I just found out today that Cigna denied me. My BMI is 47 and I met all of the requirements and my insurance includes bariatric surgery!!!! Of course it's the weekend so I cant call my surgeon's office. Talk about a big let down!!! How can they deny me? ???

[azjanie 43]

Maybe it's just something simple that was left off the submission paper work, I am sure your appeal will be approved but I know it has got to be frustrating. I am so afraid that Cigna will also find some way to deny be.

[overdue 5]

I truly hope that's all it is and I hope that my appeal goes quickly! I just can't imagine where the ball was dropped..... have you already submitted your request for approval?

[kvdme 64]

There are soo many micro things that it can be denied for.

Simple wording, 90 days wt monitoring, if 1 month of that isn't a full 30 days in between visits. Denial

Your PCP release for surgery must say Approved and recommended for surgery, If it doesn't it will be denied. The 90 day wt monitoring is actually 120 day and it must be 30 days or more between visits. It has to be detailed... details of exercise, details of diet and details of wt.. details details details. My PCP started mine, wasn't even close to be what is needed. I went to another recommended by my surgeon who knew exactly what was needed on the reports.

Dietician must approve and recommend,

Must pass psyc exam

If you got those right should be good to go. Go over your paperwork and look and see if it covers it all. Some surgeons office are not that great at making sure its all here.

Good luck

[azjanie 43]

not yet. My insurance coordinator is very picky. I have had to get several of my doctor's letters redone because something was written in correctly or left out. I had originally send a PA and she had be get actual Physician's signatures instead. hopefully, when she finally does submit my claim it will be approved the 1st time.

[southernsoul 773]

If they denied you, they are required to provide the reason for denial. Once you know what the reason is, you will know what to do next. You might not have to start an official appeal if it's just something simple like a document missing or something easy that can just be re-submitted. It's likely that your surgeon's office person has dealt with denials & re-submitting stuff before, so they may be able to help a lot. Good luck!

[overdue 5]

Thanks everyone. ... your comments definitely give me hope!!!! I was feeling a bit overwhelmed.

[easye256 50]

Dont feel too bad about it. I was denied 3 times for a whole slew of "mirco" things. Just took a little time and patience (and a good rep at the surgeons office) to get everything in place. On the fourth try, I was approved (today, actually). Dont give up, it seems pretty typical with Cigna

[denicedowns 3]

If they denied you, they are required to provide the reason for denial. Once you know what the reason is, you will know what to do next. You might not have to start an official appeal if it's just something simple like a document missing or something easy that can just be re-submitted. It's likely that your surgeon's office person has dealt with denials & re-submitting stuff before, so they may be able to help a lot. Good luck!

I just found out today that Cigna denied me. My BMI is 47 and I met all of the requirements and my insurance includes bariatric surgery!!!! Of course it's the weekend so I cant call my surgeon's office. Talk about a big let down!!! How can they deny me? ???

I asked my doctor to do a peer to peer consultation. After my surgeon talked to the Cigna doctor mine was approved. Good luck.

[denicedowns 3]

I had to get my surgeon to do a peer to peer consultation with the Cigna Doctor. Took a 2 weeks to get it done, but I was approved after they talked. Good luck.

[overdue 5]

As it turns out, my coordinator did not submit my pcp approval and my psych evaluation :-( .. she faxed it today and I pray to have an approval in 7 days.

Edited October 29, 2013 by overdue

[moviegirl333 0]

To kdvme, or anyone else who may have a sample letter that your primary care provider supplied, can you post it (deleting any private info, of course)? I need to provide my primary care doc a letter to be sent to Cigna because she is not familiar with the band, and I have complications with mine and need it removed. In order for Cigna to approve the band removal and the revision to the sleeve, all in the same surgery, the letter needs to be compelling. It has slipped to the base of my esophagus, causing me to end up in the ER a few weeks ago. Any help for a letter like this would be greatly appreciated. We need the surgery to happen in 3 weeks from now, due to the fact that it will be in another state and logistically we're somewhat tied to that timeframe.

[easye256 50]

To kdvme, or anyone else who may have a sample letter that your primary care provider supplied, can you post it (deleting any private info, of course)? I need to provide my primary care doc a letter to be sent to Cigna because she is not familiar with the band, and I have complications with mine and need it removed. In order for Cigna to approve the band removal and the revision to the sleeve, all in the same surgery, the letter needs to be compelling. It has slipped to the base of my esophagus, causing me to end up in the ER a few weeks ago. Any help for a letter like this would be greatly appreciated. We need the surgery to happen in 3 weeks from now, due to the fact that it will be in another state and logistically we're somewhat tied to that timeframe.

this is what my doc wrote me, Cigna had no issues with it. All of my denies had to do with the location of procedure and some mix up with psych paperwork

Edited October 29, 2013 by easye256

[LittleLou 31]

Doesn't it bother you that your insurance coordinator failed to submit two of the biggest requirements that CIGNA has? And not just CIGNA, but I think most insurance companies require the PCP letter and psych eval. I just don't understand how that happens.

[kvdme 64]

To kdvme' date=' or anyone else who may have a sample letter that your primary care provider supplied, can you post it (deleting any private info, of course)? I need to provide my primary care doc a letter to be sent to Cigna because she is not familiar with the band, and I have complications with mine and need it removed. In order for Cigna to approve the band removal and the revision to the sleeve, all in the same surgery, the letter needs to be compelling. It has slipped to the base of my esophagus, causing me to end up in the ER a few weeks ago. Any help for a letter like this would be greatly appreciated. We need the surgery to happen in 3 weeks from now, due to the fact that it will be in another state and logistically we're somewhat tied to that timeframe.[/quote']

I sure will