Cigna Denied ... peer to peer?

[megieg 7]

I heard from Cigna today stating I was denied because they did not receive my 3 month diet or other physician recommendation. They said they was now waiting on my surgeon office to set up a peer to peer? What does this mean and what do we have to do now bc I have completed those and had faxed them over to my surgeon along with all of my other stuff, I'm not sure if they lost it or what. I am devastated. If they do a peer to peer will I likely have a higher chance to be approved ? Will this push back my surgery that is set for august 28?

[ohjul 51]

They were going to do the same thing= peer to peer is the coordinator talking to their office- mine was cleared up because they didn't read all the paperwork - it was cleared and approved within 10 minutes of their talk. so- call your dr office and tell them what you heard- and they will call in. or at least mine did- Good luck- don't back down!

[smkallen67 31]

My docs office submitted almost 2 weeks ago and today Cigna said they didn't have all the info they needed and was going to deny when everything they said was missing WAS submitted. The nurse is resubmitting today what was missing and hoping for approval. Just BS that they say stuff is missing when it's their in front of them to hold up the process. Very frustrated. Wanted to hear accepted this week since I did all I was suppose to and all was submitted. UGGGH! No guarantees I understand even if you meet all the qualifications. Just have to pray and be patient something I am not very good at.

Sue

[megieg 7]

I have yet to hear from my insurance or surgeon's office as to what is happening. I know they denied for missing stuff and the patient advocate stated she had faxed it in. I hope to hear something soon.

[BizzyB 119]

A peer to peer is your doctor talking directly to the insurance medical director. I was denied and my surgeon was able to get the decision over turned by talking with the insurance company.

[Daisee68 2,493]

I have Cigna and while I haven't been thrilled with the times I have had "medical director denied as not medically necessary", I have always found the customer service people to be VERY helpful. I would suggest calling Cigna yourself and see if one of those individuals could tell you exactly what was missing that caused the denial and ask if you can submit those items yourself. While your patient advocate at the surgeons office SHOULD be doing this, they apparently are not so you have to kind of take hold of the reins yourself. There are appeal procedures so you should find out what those are and file your own appeal along with all the documents and I would cc your surgeons office and send them a copy. Good luck! They did approve mine in less than 24 hours of all documents being provided. Now 5 weeks out they still haven't paid the hospital likely because they are arguing some items but they will pay eventually and I will stay out if that for now. PS have you seen the document online that tells you exactly what Cigna requires? Let me know if not and I will send you the link.

Edited July 11, 2015 by Daisee68

[ginner1966 3]

I have Cigna as well. Could you send me the link to their requirements?

[Daisee68 2,493]

@@ginner1966 - I know this is an old post so maybe you don't need this anymore but here is the link https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[Blueeyes66 11]

Im new to this...but I have cigna and just today finished everything Cigna required.

I had been denied by my psych, and he told me if I would do 3 sessions of therapy he would ok it,

Will doing these sessions help me with getting approved?

[Daisee68 2,493]

@@Blueeyes66 - Cigna does require psych approval so if he will approve you after the 3 visits, it will definitely help. .are sure you have everything else done including letter of recommendation from a Dr other than the surgeon (this was the last thing I needed and luckily my endocrinologist did it very quickly).

[Blueeyes66 11]

Yes...I will get my letter for my surgeon tomorrow showing my therapy completion. and my final consult is Oct.5th.I'm excited.and worried.

[AllisonK1986 68]

Yea I was denied on Friday for same thing. Am going to call my office in Monday and get them to send in more info and to work with Cigna on getting approved. Thank goodness my surgery isn't until end of November. It will give me some time to get all this worked out.