CIGNA people-How long did it take for approval/denial?

[bfyneNtyme 0]

Joan,

My real name is Vanessa.

[michiganer 0]

Nothing yet but I haven't submitted my paperwork. I have everything I need but I noticed a few typos in the letters that my nutritionist sent me. She sent a letter every month detailing what we went over in our sessions. But I turned 26 in the middle and she never changed my age in the letters. Also, she dated all of the letters on the day I had my appointments. My very first appointment with her was on January 29th. My last appointment was scheduled for July 23rd. I realized that July 23rd would not make for an entire 6 month program so I changed my last appointment to July 31st. I had heard that if the program is not exactly 6 months, people were getting denied. So the last letter she sent me had the original appointment date on it of July 23rd.

I spoke with her Friday and she said she will make the changes and send the revised letters out Monday. So its back to waiting for now

I was a little upset by one of my doctors last week. It is my primary care doctor. He hasn't really seen me much in the last 5 years but I did go to him to ask him for a letter of medical necessity. He said he would write one. I didn't give him any examples because he said he has written them before. Big mistake. I got the letter and it was almost like he was trying to convince the insurance company NOT to approve the surgery. The whole letter was basically his opinion and not facts about my medical history. He said things like "Trisha has tried many diets but has failed because either lack of determination or not seeing results fast enough" and "this invasive surgery is Trisha's path of choice". Totally inflammatory words! I was so pissed and disappointed!!

I also asked my endocrinologist to write me a letter of medical necessity. He has seen me regularly for the past 5 years and he knows that I have hypothyroidism, polycycstic ovaries and pre-diabetes. he is the best doctor I have ever had! I got his letter Friday and it was the most awesome, heart-felt, informative letter! He phrased everything in such a professional manner, using proper medical terminology. He told about how I have struggled over the years and how my conditions hinder my weight loss. He fully recommended the surgery. He definitely made it sound like this is life or death for me. Everything was right on! I thanked God so much for that!

I also had another semi-bad thing happen to me yesterday. To give a brief background, I am very close to my best friend. We have know each other since 6th grade and we are as close as sisters. I am pretty close with her family too. I told her that I didn't want to say anything about my surgery to anyone until I was ready. I told her I don't even know if I ever want to tell. She has been very supportive and completely understands. We are also roommates and we can't afford to live apart. She just got a pretty big job offer that would force us to live apart. I was freaking out because I can't really afford to live on my own and I don't really have any family here in Florida I could live with. Eventually, I would move with her but I need to stay at my job right now because of the insurance. I was really scared about how I would live on my income alone. She told me not to worry because I could live with her mom. I didn't want to because I don't want to be a moocher even though I feel like a part of her family. Her mom was insisting and kept asking why I just didn't quit my job and move with my friend now. I decided that I would tell her mom about why I am waiting. I explained the surgery and told her about my reasons etc. Her reaction was just what I am afraid of in other people. She kind of looked at me like I was an alien and said things like "Why don't you just eat less food"? and "If you exercised and ate right wouldn't you lose weight"? I hated it. I felt like I had to defend myself. I basically told her I have medical conditions, my doctor is behind me and it is a personal decision I made for myself. I honestly don't think her mom was trying to be mean, I think she considers me one of her kids and she doesn't really like the idea of surgery. My best friend defended me which was nice. Nonetheless, it just reminds me that I need to keep this under wraps to certain people.

Whew! I didn't mean to write so much but I guess more has been going on than I thought. After I get the paperwork together and submit it, I will keep you all updated.

[tanderson 3]

I also asked my endocrinologist to write me a letter of medical necessity. it was the most awesome, heart-felt, informative letter! He phrased everything in such a professional manner, using proper medical terminology.

This would be the ONLY letter I would send if it were me...

[michiganer 0]

I was thinking the same thing. The rules are that I am supposed to get a letter from my PCP but I think my endo should suffice. I think the insurance coordinator will agree too.

[Sooverit! 1]

Oh my Gosh Vanessa...(one of my favorite names by the way) I am sorry I don't know why but I thought you were a male. I am relieved because I was starting to think that Cigna perferred men and I had a female discrimination if they didn't cover me! tHANKS again for all your generous guidance. How are you doing with your band!? It sounds like life back to normal for you?

Fondly,

Joan

[dmtjet 0]

:clap2:My doctor hired an attorney to fight with the insurance companies! It still took a year and a half to go through and earn an approval! That was only after 3 denials!!! I really was about ready to say forget it!!! So glad it worked in my favor! Doc said that with time, all the insurance companies will be approving it, because it is still cheaper for them to pay for the surgery than a lifetime of illnesses that goes with obesity!!! Good luck to all still fighting! I wish you the same results that I received!!! Best Wishes!

[Big Fred 0]

I am scheduled for my surgery in October, have had all the tests (Psych, Stress, Blood, etc..).

Called the office today to make sure I'm on track, the coordiantor told me that CIGNA has just informed them that they will not pay for an overnight stay - only monitoring after the surgery. I asked her what that means and she told me she wasn't sure. It could possibly be treaed as a one-day-surgery or CIGNA apparently will pay for the monitoring after the surgery and if your OK to go home you wil have too - if not they will keep you.

The office is evaluating this and may postpone surgeries until it's hashed out. Just my luck, I hope this gets finalized before my surgery date.

Just thought I would let everyone know, I will keep you posted as I find things out.

[michiganer 0]

I have been on vacation for 2 weeks so I haven't posted the latest. I just got approval from Cigna for an office visit with US Bariatrics! This is just my foot in the door. I still have to get them to approve surgery but at least I have something. Amanda who is the insurance coordinator said that because they are out-of-network, getting Cigna to approve an office visit will help us when we submit everything for surgery approval. I am expecting a call from their nurse who will ask me a bunch of questions and decide if I need any more clearances like cardiac clearance. Hopefully she will call today and we can get this thing moving!!

[Big Fred 0]

Well, today's the day the paperwork goes in.

Boy, six months went by fairly quickly. The coordinator says it may take 2-3 weeks for a reply, she has seen it take as little as a week. I guess I'll give it two weeks and if I don't hear anything give them a call.

If I get an approval before 10/11, that will be my banding date. They have me penciled in for that date.

After jumping through all the hoops they give you I certainly will be pissed if I'm denied.

Stay tuned and wish me well, I'll let you know what happens.

My thanks to everyone in this forum for their kind words and support, this place has truly been a godsend.

[cathie 0]

Tanderson- how did you get cigna to approve you sooo fast.

[michiganer 0]

Well, today's the day the paperwork goes in.

Good luck Big Fred! Here's to a LITTLE Fred!!

[Forestcat5 1]

bfyneNtyme -

Thank you so much for this information! I was denied by cigna a few weeks ago for not having enough documentation of the 6 month weightloss. For whatever reason, the surgeons office only had 2 months of documentation from my Dr, but sent it in anyway.

I have been trying to be patient and not bug anyone too much, but after reading about your experience I've decided to "call, call, and call again!"

I called the surgeons office and my Dr's office last Thurs and left messages asking them to call me back to let me know if the rest of my documentation had been sent in, and neither one called back. So Monday morning they will be hearing from me again. And if it WAS sent in - the next call is to CIGNA!

Thanks again!!

Forestcat

[michiganer 0]

Ok everyone, please continue praying for me. My paperwork was officially submitted yesterday for approval with Cigna! I have been waiting for this day forever! I am praying and praying that they will approve me! I will let everyone know when I hear something. Thanks! Trisha:)

[Donnajade 0]

I just posted this on another thread but wanted to let you know that my Dr's office submitted my paperwork to Cigna on Monday and I got approved yesterday. My surgery is scheduled for the 23rd of October. So for me it took 3 days for them to approve. I had to do the 6 month diet with my pcp also. Good luck to everyone with Cigna.

Donna

[Big Fred 0]

Donnajade;

Congratulations !!

I can only hope that Cigna will approve me, the earlier the better. Browsing through the posts you can read many horror stories of people being denied or having to re-submitt.

If everything goes well, my tentative surgery date is currently 10/25. I hope that we can swap stories soon after that.

Again, congratulations and good luck.................