SO FRUSTRATED!

[n_green825 5]

Hello,

I'm new to the forum world so bear with me. Any who, I went to my surgeons office for my pre-op and to get a surgery date. This company is soooooo unorganized! I was done with diet & nutrition last month... They dropped the ball with my insurance as far as updating it even though I kept telling them as of Jan 1st I had new insurance. Well, same company but now I have out of network coverage. Anywho they switched me surgeons and come to find out the soonest they have for surgery is March 14th* if a patient cancells, OR March 31st. Grrrrrrrrrrrrrr!!!!!!!!!!! This is ridiculous. I was done with my check list on the 5th of this month. My surgeon said he has an opening on Tuesday, yes that's 4 business days away... BUT I don't have my insurance approval yet. They just barely submitted TODAY. I'm so irritated. Anyone have experience with Cigna open access plan? I know we all hear the basic 5 - 10 business days with a max of 30 days to respond but I need to know does it really take this long?!

[Daisee68 2,493]

Cigna approved mine in 24 business hours (submitted Friday at noon and approved Monday morning before noon). Fingers crossed yours will go just as fast!

[Valentina 2,642]

A doctor to doctor conference call will usually get the job done.

[n_green825 5]

Daisee68, thank you so much for replying! That totally gives me hope! I know they're pretty good with claims, as far as processing ASAP so I'm hoping approval is the same. The employee in charge of submitting was just so negative... she kept telling me, well I can't even escalate it until it's been 5 business days blah blah blah.

So when is/was your surgery date?!

Thank you!

- Nancy

Cigna approved mine in 24 business hours (submitted Friday at noon and approved Monday morning before noon). Fingers crossed yours will go just as fast!

[n_green825 5]

Thanks for your reply Valentina!

Yeah that's what the surgeon said, he was like I'll call them if I have to... he was more helpful than his staff! Unbelievable. If I wasn't so close to getting this thing done, I would find another clinic. Ugh.

-Nancy

A doctor to doctor conference call will usually get the job done.

[Daisee68 2,493]

@@n_green825 - will keep my fingers crossed for you! So glad your surgeon agreed to get involved! My surgery was June 4 last year. I'm down a total of 128 pounds (27 of that before surgery diet and liquid per-op diet).

Sent from my HTC One M9 using BariatricPal

[n_green825 5]

Oh, I just noticed your ticker, Lol. That is so awesome, congrats! I cannot wait to start shedding some pounds! I'm on the pre-op diet now, 2 shakes a day, small healthy dinner... but with my surgery date up in the air, I'm losing motivation. My starting weight will be 252, with a goal of losing 110pds. I'm a shorty... 5'2" Lol.

@@n_green825 - will keep my fingers crossed for you! So glad your surgeon agreed to get involved! My surgery was June 4 last year. I'm down a total of 128 pounds (27 of that before surgery diet and liquid per-op diet).

Sent from my HTC One M9 using BariatricPal

[Chair1311 58]

I have Cigna as well and as of today I have been denied twice. My procedure is set for the 23rd and I have been on pins and needles waiting for a response for the second denial. The lady at the surgeons office said that the Cigna I have rarely denies claims. There is a Dr to Dr call tomorrow between my surgeon and the Med Director so hopefully all will work out. I am praying.. Stressed but praying.

[Daisee68 2,493]

@@Chair1311 - So sorry this has happened. Hopefully the dr call will help. What was the reason they gave for denial?

[Chair1311 58]

@@Chair1311 - So sorry this has happened. Hopefully the dr call will help. What was the reason they gave for denial?

The first denial was a lack of a signature from the nutritionist. This time, I don't know. The lady at the surgeons office didn't know either.

[Valentina 2,642]

The lack of a signature????????? WTH???? I would go and visit with the office administrator and together go over EVERY line of your forms. Someone's careless submission of an incomplete form should NEVER be a reason for a patient's application to be denied. OMG!

You don't have to be abrasive or disruptive, just "gently assertive"...

I would also "gently assert" that you "need and expect" your surgeon to indeed make the "doctor to doctor" conference call.

I'm trying to think of a time during my years as a medical facility administrator when a doctor to doctor conference call did not work. I can not think of ONE. As far as my memory will allow, the doctor to doctor call works. It makes it personal. Especially when one remembers that most of the time, the people making the "approve/deny" decisions are NOT doctors, but money crunchers. Scary, isn't it?

PLEASE, keep us posted. We care and am rooting for you.

[Chair1311 58]

The lack of a signature????????? WTH???? I would go and visit with the office administrator and together go over EVERY line of your forms. Someone's careless submission of an incomplete form should NEVER be a reason for a patient's application to be denied. OMG!

You don't have to be abrasive or disruptive, just "gently assertive"...

I would also "gently assert" that you "need and expect" your surgeon to indeed make the "doctor to doctor" conference call.

I'm trying to think of a time during my years as a medical facility administrator when a doctor to doctor conference call did not work. I can not think of ONE. As far as my memory will allow, the doctor to doctor call works. It makes it personal. Especially when one remembers that most of the time, the people making the "approve/deny" decisions are NOT doctors, but money crunchers. Scary, isn't it?

PLEASE, keep us posted. We care and am rooting for you.

Oh I have been on the phone so much with both my insurance and my surgeons office they probably have memorized my phone number! Lol I am praying with everything I have. I work in an emergency room so we never have to deal with insurance claims and authorizations. My Dr will be on the call tomorrow. Apparently he has been just as shocked as I that I wasn't approved! Thank you so much for your advice and encouragement. I will let y'all know how it turns out.

[n_green825 5]

@@Chair1311, Oh nooooooooo!!! That's horrible, I'm so sorry! Keep us posted! I know it's only been 2 days since they submitted, but I feel like calling Cigna today anyway and seeing if I even have a case # or something I can track. I HATE the waiting game!

I have Cigna as well and as of today I have been denied twice. My procedure is set for the 23rd and I have been on pins and needles waiting for a response for the second denial. The lady at the surgeons office said that the Cigna I have rarely denies claims. There is a Dr to Dr call tomorrow between my surgeon and the Med Director so hopefully all will work out. I am praying.. Stressed but praying.

[Chair1311 58]

So Cigna approved me today for my surgery on Tuesday!!! My representative at the surgeons office said the doctors didn't even talk. She ironed everything out the the med director herself! I am sooooo excited and now so nervous! Thank you everyone for your advise and support.

[Chair1311 58]

@@Chair1311, Oh nooooooooo!!! That's horrible, I'm so sorry! Keep us posted! I know it's only been 2 days since they submitted, but I feel like calling Cigna today anyway and seeing if I even have a case # or something I can track. I HATE the waiting game!

I have Cigna as well and as of today I have been denied twice. My procedure is set for the 23rd and I have been on pins and needles waiting for a response for the second denial. The lady at the surgeons office said that the Cigna I have rarely denies claims. There is a Dr to Dr call tomorrow between my surgeon and the Med Director so hopefully all will work out. I am praying.. Stressed but praying.

Call Call Call!!! You have to be on top of them. It took the threat of a Dr to Dr call to get me approved today. Get your surgeons office involved also. Good luck!