Insurance approval

Sooverit! · April 19, 2008

Believe it or not I rushed into this

It's taken me almost a year and a half of work but it's over at least. This...meaning insurance approval with Cigna. I was Denied because I was shy a 40 BMI by 10 -12 pounds when I submitted everything they were looking for I jumped thru every hoop and paid out every last cent to docs. etc. but I should have know (and not listen to people on this site that said Cigna does cover with no co mobidities - NOT TRUE) they clearly state that they do not cover those under a 40 BMI unless you have grave illness that don't respond to meds.. Not only that but they will not approve any claim even related to this one in the future. Meaning if I gain 10 pounds in the next year.even if I maintain that for a year and..easy to do at my age...they won't even consider it.

My fear is of dying of a heart attack like my twin sister did of obesity last year. My chest is so huge it strangles me at night and causes sleep apnea that doesn't appear on the "test" ...another few hundred bucks there.

My warning to those seeking insurance approval with CIGNA....if you're not starting out with a 40 BMI save your money until you are or get a loan unless you can clearly prove a comobidity.

__________________

georgia girl · April 19, 2008

Hello Sooverit. I am really sorry that you were denied coverage. That sucks, especially since you have put a 1&1/2 years into this.

Is the lapband out of picture for you now, or is there any way you can go the route of self pay or get a loan?

Sorry this happened to you and I wish you the best!

PS, I am sorry about your sister. I hope and pray you can find a way to make this happen.

Sooverit! · April 19, 2008

Dear georgia girl:

You are a sweatheart and a very kind person. I hope this doesn't sound odd but when I saw your picture I was stunned at how much you looked like my beautiful sister when she was young.

I have been thinking all day...that I could either Switch Insurance Companies, get a loan, or lose the weight on my own. All not easy choices but maybe the loan part could be the most viable. Though I'm in no position to be in debt. I'll pray on it. And again Georgia your kind words helped to ease the sting of this new today.

Gratefully,

marg

Hello Sooverit. I am really sorry that you were denied coverage. That sucks, especially since you have put a 1&1/2 years into this.

Is the Lap Band out of picture for you now, or is there any way you can go the route of self pay or get a loan?

Sorry this happened to you and I wish you the best!

PS, I am sorry about your sister. I hope and pray you can find a way to make this happen.

Today 09:41 AM

georgia girl · April 19, 2008

Dear georgia girl:
You are a sweatheart and a very kind person. I hope this doesn't sound odd but when I saw your picture I was stunned at how much you looked like my beautiful sister when she was young.

I have been thinking all day...that I could either Switch Insurance Companies, get a loan, or lose the weight on my own. All not easy choices but maybe the loan part could be the most viable. Though I'm in no position to be in debt. I'll pray on it. And again Georgia your kind words helped to ease the sting of this new today.

Gratefully,

marg

That's sweet of you to say. I know you miss her and I send you my condolences.

I'm glad to hear you are not giving up. Sometimes it's easier just to give up and go back to our old ways and I commend you for trying to find a way to make this happen. You are quite a trooper. Whatever happens, I wish you the best and I hope everything works out for you. Keep us posted on your progress.

Sooverit! · April 19, 2008

I meant to say that you should be able to clearly substantiate the co mobidities that CIGNA specifies. I had almost a dozen "co mobidities" but they are in check with meds. I hear of those denied with a 40 BMI as well. I could apeal their denial but that is going to cost money and headache and :cool:I'm just not about to give out anymore.

Enchanted · April 20, 2008

I could be wrong, but I don't think it costs money to appeal an insurance company's decision. All of my docs agreed that I should have the lap band and each of them said that if I had trouble with my insurance company (Anthem BC/BS), I should let them know and they would work with me and the carrier.

Thankfully, my surgery was quickly approved.

I hope you don't give up. Be the squeaky wheel. This is important.

Sooverit! · April 20, 2008

Well I was 7 pounds shy of being covered and I will never be able to be covered by Cigna any time soon. I feel I should post their letter to me dated March 31, 2008

After review of the information submitted by your provider and the terms of your benefit plan, we have determined the requested services are not covered for the following reason:

Body mass index should be greater than 40 for at least one year and or BMI is between 35 and 39.9 for at least one year and the patient has one or more documented clinically significant co-mrbid conditions (1) that have failed to respond adequately to non -surgical treatment methods including appropriate and adequate medication; I think with Cigna the big 2 they will cover the Lap Band for are sleep Apnea and Type II Diabetes and or High blood pressure. But again they may only cover these if they don't respond to med or machines~

Also they threw in the middle of a long paragrah "Any claims associated with the denied request will not be considered for payment" period!