Cigna denied twice

[Carrie_C 9]

Cigna has denied me for the second time. They denied me the first time because they said they didn't receive the nutrition eval consult. Now they have the eval and they have denied me again because they want another letter from the dietician. (The RD is working on the letter). I think they are just knit picking to try and get out of paying. Has anyone else had this happen? I am not sure what to do now.

[TerriDoodle 6]

Oh, there are several people on here who were denied SEVERAL times for various reasons. I can't remember her name now, but I remember one lady who was denied 5 times...and on her 5th appeal they finally approved her. The lesson is DO NOT GIVE UP until you've exhausted all avenues. Insurance companies will indeed sometimes make it very difficult.

[Carrie_C 9]

Thanks, I needed to hear that. I feel like throwing my hands up and saying forget it.

[TerriDoodle 6]

Yeah, that's what they count on!!!

[cathychatts 1]

My surgeon's office is going to submit my paperwork today. I hope I don't encounter too many problems. I fought with them over my phyc evaluation and they finally got it approved... and then they didn't pay. Their communication sucks.:biggrin:

[Carrie_C 9]

They didn't pay for my psych eval either. My surgeon's office resubmitted everything the other day, so I hope they don't find another reason to deny.

[oscarel 0]

Carrie,

I just had my psych exam denied by Cigna as well. But I called them and they told me that I actually have "mental health" insurance through a different company. Not only does the mental health insurance cover it, but the copay was also $10 cheaper. I had to be pre-approved and the lady I spoke with back-dated the approval. So you may want to check and see if this is the case for you too! On my insurance card there's a different number listed on the back at the bottom that says MH/SA. Good luck with your surgery approval I'm 2 months away from that headache.

[Carrie_C 9]

Thanks. The surgeons office had a package deal with the psych eval and the nutrition eval for $95, so that's what I did. They never mentioned anything about insurance covering it. I think they are just ripping people off. They are making me pay 2 "program fees", I had to pay $105 at the consultation and I have to pay $1000 one week before surgery. And that is in addition to what I have to pay that insurance doesn't cover. My insurance covered the consultation, but the office still made me pay the $105. They call all of this program fees, and I have no idea what that means. Has anyone else had to do this?

[celticdreamer 0]

Carrie,

I feel very bad for you and have a couple of pieces of advice.

1) Don't pay your surgeon's office program fees until you have an understanding of exactly what you are getting for your money. You have a right to know what you are purchasing. The fact that they made you pay $105 for a visit the insurance covered seems a little sketchy to me. Is this surgeon reputable? Please make sure you do plenty of research before you invest your money and your health in this office.

2) If CIGNA continues to deny you, get an attorney. In the long run, it'd be a lot cheaper than footing the entire surgery bill on your own. I'd suggest appealing on your own at least once more, though. I used to work for Cigna, but had nothing to do with claims or pre-approvals. I left there when I found a job with better insurance.

Don't give up without a fight. They have ridiculous prerequisites for weight loss surgery, then end up denying anyway. Make sure you meet all the requirements then FIGHT FIGHT FIGHT.

Don't let people walk all over you - whether it's Cigna or your surgeon's office.

Take care,

Theresa

[cathychatts 1]

Hi Carrie:

I also have Cigna through the State of Tennesse. You can go to the web site for Cigna and find information concerning the surgery going to this link http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

or just call the phone number on the back of your card. I have called several times. I had a little difficulty getting them to pay for the phyc evaluation, but I did succeed after a few trys. That is covered by Cigna, not the Megellan, because it is a requirement for the surgery. Your mental health carrier will deny it. There was no "in network" provider available so they arranged it with the Doctor of my choice. They will also pay for the nutrionist and the 6 month diet plan also. You just have to be sure the provider codes everything correctly.

Be sure to call Cigna yourself, it makes it much easier to get things moving.

I have completed all the necessary visit, test, paperwork and now just waiting for the surgeon's office to submit. I even called Cigna to see if the paperwork had arrived and they happily checked for me. The main thing to remember is to be nice :mellow:when asking and they will bend over backwards to help. It is hard to be sweet sometimes when we are so aggitated, but it does work.

Good luck! :ohmy:

[Carrie_C 9]

Thanks everyone. The surgeon's office has appealed, and they sent in everything to Cigna last week, so I am just waiting to hear. The surgeon is very reputable. I asked about all the fees they charge and they said they are allowed to charge them as long as they tell me ahead of time. They gave me a paper about what all the fees are for, I just haven't had a chance to read it all. I had called Cigna last week, and they said all they needed was a letter from the RD about the nutrition consult. I am hoping they approve me this week. I would just like to get on with it!

[cathychatts 1]

I just called Cigna and they have not even received the paperwork from my Surgeon's office. The clerk has not even sent it yet. That really bums me out! :frown: