3rd Try for Cigna Approval...Does the Peer to Peer Review Normally Work? (Cigna)

[Theex01 1]

So my Surgeon's office submitted all "complete" documentation for VSG, only to get it kicked back from Cigna stating they need CPT codes, a surgeons letter and also a formal nutritional evaluation. So surgical coordinator submitted a "reconsideration" with all additional info.

Then it got kicked back again because they wanted an in depth nutritional evaluation from an registered dietition. I completed that last week and surgeons office re-submitted.

Now Cigna is saying they will not accept any more reconsiderations (I guess 1 is the limit) and now there is a peer to peer review scheduled for tomorrow afternoon. My surgery is scheduled for 6 days away!! It's been pushed back a week already. I'm nearly sick from the stress. Apparently my surgeons office never has this problem with Cigna and we have submitted absolutely everything insurance requires.

Has anyone gone through the peer to peer review process and been approved? I'm so nervous!

[Sharon1964 2,530]

The reviewer has to have a specific reason to deny. It doesn't sound like there is a reason. Not to worry.

Edited June 12, 2015 by Sharon1964

[lexiemia 78]

I have Cigna and they did a peer to peer review and it got approved. Wishing you the best.

[Theex01 1]

Thank you both for the information, it has eased my nerves a bit! I'll give an update when I hear back on my answer tomorrow

[fldianna 8]

Hi just wondering if you ever got approved?