Cigna - Denial Due Location??

[Jenaee 5]

My office recently submitted my paperwork to CIGNA for approval. I received a decision within a day but the claim was denied due to where I’d be having the surgery. Cigna stated the location where they wanted to perform the surgery as outpatient is not on the 2019 Bariatric Center of Excellence list. I checked and the surgery center is in fact on the list. I actually had my EGD performed there and they paid that claim.

I called CIGNA and the rep stated that the ruling they gave is not accurate and outdated. The rep also stated that the case manager is reaching out to my office to rectify the issue.

I am frustrated but trying to remain hopeful. Has anybody ever been initially denied by CIGNA and then approved?

[New&Improved 1,780]

Sounds like a computer error will be fixed soon

[GreenTealael 25,385]

👏 STAY 👏 ON 👏 TOP 👏 OF 👏 THEM 👏

Keep track of everything, request written/email copies, calls be recorded, representatives names & ID numbers etc., call Everyday if you need to since its obvious they can't get there own **** together.

GOOD LUCK 💙

[Jenaee 5]

38 minutes ago, GreenTealael said:

👏 STAY 👏 ON 👏 TOP 👏 OF 👏 THEM 👏

Keep track of everything, request written/email copies, calls be recorded, representatives names & ID numbers etc., call Everyday if you need to since its obvious they can't get there own **** together.

GOOD LUCK 💙

Thank you! I will definitely chase them on this!! I did not go through this whole process to be denied over a location. It’s ridiculous!

[FluffySaysForkIt! 823]

While this did not happen to myself, I have seen others post with this exact same issue.

Keep at it and coordinate with your Doctor's office. I am sure you can get it resolved. Good Luck!

[Panda333 276]

EXACT SAME THINK HAPPENED TO ME WITH AETNA WAS A DISASTER....GOT ME OFF TRACK FOR A MONTH AND SURGEONS OFFICE (THE ADVOCATE) WAS WASHING HANDS OF ME. i STAYED ON THEM AND GOT IT!!

[mousecat88 2,281]

Seems like a minor administrative issue. My recent MRI just got denied because "I didn't have a prior authorization", even though I had the authorization confirmation from the insurance and was standing there when the doctor called for the auth. They fix that stuff right away.

[Jenaee 5]

So here's the update:

I did my own research and I saw the name of the facility on my claim was not the same as it appears on the Centers of Excellence list.

So I called the insurance coordinator and told her my findings. She said she talked to Cigna and the topic of the differing names never came up. She offered to have my surgery at a hospital that is definitely on the list. I told her that was fine. She said she would schedule for a different date and let me know when it would be. This was on Tuesday.

On Wednesday, she calls and says that I was right and the original claim did not have the correct legal name of the facility. She’s speaking to Cigna again today and for now, we’re keeping the same date/facility.

Patiently waiting on a resolve.

[Jenaee 5]

Last update:

I am now APPROVED!! This is a cautionary tale of staying on top of your docs office staff and doing your own research.