Long time no fill...

[TxArcher 2]

So I have been pretty down lately about my perspective with my band. I have not been eating the "best" foods. Some sweets here and there. Most days, I can eat too much. Some days I am tight, but it never lasts long. I think this move to SC has messed with my head. I was ROCKIN in Texas, but now I have come to a screeching halt.

To top it all off... I have been trying to get hooked up with a new surgeon here in UPstate, SC to follow me. Today it finally happened. My old Surgeon's office got in touch with them and Dr. Bour accepted me. That is good news, I know. The bad news is that I can't be seen 'till Aug. 8th and there is not an opportunity for a fill until September 8th! That is a LONG time from my last fill in APRIL:eek:

I guess I just need to suck it up and stay the course 'till I can get another fill and make my daily choices to eat healthy and not too much!

I am just venting... Oh yeah... I am STILL fighting Cigna for payment on my surgery! They are pulling any excuse out of their "you know whats" to keep from paying! Anybody have any suggestions?

I am furious with Cigna at this point!:confused::mad::sleep::mad::eek::mad::mad::drool::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad::mad:

[kansascase 0]

Did you talk to a nurse in the doctor's office that you need a fill? I don't understand why they can't do it during your August appointment. What does it take - 5-10 minutes.

I would be quite angry too! I feel for you. I think I would consider finding another doctor. I don't know if you could get in any sooner but at least you might find a doctor that can be a bit more flexible and willing to work with you.

[TxArcher 2]

Did you talk to a nurse in the doctor's office that you need a fill? I don't understand why they can't do it during your August appointment. What does it take - 5-10 minutes.

I would be quite angry too! I feel for you. I think I would consider finding another doctor. I don't know if you could get in any sooner but at least you might find a doctor that can be a bit more flexible and willing to work with you.

It has taken since April to get hooked up with this Dr. He is the only option I have unless I want to go to fill center usa in Charlotte, NC.

I guess I can wait it out...

[hollyberries 2]

Archer Man....first I feel for you! That is a long time to wait.

Now put your hand out so that I can slap it. You can't be away from your Nymph family this long. You need support and cheerleading. We are here for you in the good times and the bad. We are your shoulders during frustrating times like now. Ok...I wooped ya.

Now...you can do this. I know that I have been right where you are and recently to boot. Look over your Band diet rules, begin doing what you were doing in the beginning. Think about the fact that you are in Bandster Hell again and just work it the best you can.

I have taken a dramatic step in the last 2 weeks and started to low-carb. I eat just Protein and veggies and I try to keep my carbs under 30 grams. It has worked for me because in the last few weeks I have dropped 8lbs.

You can do it....and we are here for you. Don't be a stranger...we miss you. Who else can I harass before football season starts...PATS training camp is in two weeks....Woo-Hoo!

Cindy

The Nymph Cheerleader :thumbup:

[Momto1plus1 0]

I would call back and see if they can squeeze you in any sooner. Try calling every day to see if there has been a cancellation. Maybe they will get tired of talking to you and get you in. LOL On the upside. Aug 8 really isn't that far away, just aggravating more than anything.

[Sades 4]

I would call and let them know you are desperate for a fill. Put yourself down for cancellation slot. I know it's hard because it's a new dr but they should understand your position. Good luck.

[cindyg1212 0]

TX, if you have to wait for a fill, try to focus on making good choices. You'll get back on track. A new move is stressful and taking away your focus.

About Cigna. Did they pre-approve the surgery? If so, what's the problem? Today I got a bill from the anesthesiologists for $1178. They put a post-it note on it saying that the insurance company inadvertantly paid their money to the surgeon. They want me to work it out. Why it took 8 months to bring this up, I don't know. Insurance companies are impossible to deal with. Why is Cigna stalling?

[TxArcher 2]

TX, if you have to wait for a fill, try to focus on making good choices. You'll get back on track. A new move is stressful and taking away your focus.

About Cigna. Did they pre-approve the surgery? If so, what's the problem? Today I got a bill from the anesthesiologists for $1178. They put a post-it note on it saying that the insurance company inadvertantly paid their money to the surgeon. They want me to work it out. Why it took 8 months to bring this up, I don't know. Insurance companies are impossible to deal with. Why is Cigna stalling?

Yeah... I will try to make wiser choices. Afterall, I am probably just beating myself up a little bit. I eat at least one meal a day as a salad. (I have this crazy hankerin' for Greek salads)

Cigna has this room full of monkeys. Really... I have seen them...:thumbup: They all have two stamps... one stamp is a "reject" and the other is an "accept". These monkeys just go crazy stamping claims. Afterall--- they work for bananas. No health benefits to pay...

Ok. I am done mocking them.

They are making up new excuses each week why they can not pay out. We are on excuse 20 or so now. I think i remember somewhere that there is a law firm that takes care of bariatric patients. Something like obesityhelp.com????? I am about to look into this.

Edited July 12, 2008 by TxArcher

[cindyg1212 0]

TX, obtaining legal help is always a good idea if you can't get anywhere. Did Cigna pre-approve the surgery? If so, call and demand to speak with a manager (head-monkey). Customer service (a term I use loosely) just gives pat answers. They look in the notes on your claim and read what's there. You need to speak with someone in a higher position. When my insurance company, Oxford, approved my surgery, they sent me a pre-approval letter. Did you get such a letter? If so, there should be no discrepancy. If not, did the surgeon obtain pre-approval? Should be in your records.

[TxArcher 2]

TX, obtaining legal help is always a good idea if you can't get anywhere. Did Cigna pre-approve the surgery? If so, call and demand to speak with a manager (head-monkey). Customer service (a term I use loosely) just gives pat answers. They look in the notes on your claim and read what's there. You need to speak with someone in a higher position. When my insurance company, Oxford, approved my surgery, they sent me a pre-approval letter. Did you get such a letter? If so, there should be no discrepancy. If not, did the surgeon obtain pre-approval? Should be in your records.

See, this is just the thing. According to the terms of my insurance at the time of services. (I have the papers here on my desk) They state:

Failure to notify CIGNA---------Does not Apply

Precertification----------------Does not Apply

Outpatient Precertification-----NO (means they don't need it)

I jumped though all the hoops they required and they are going on and on with different letters (about 1 a week) with new reasons that they can not cover my surgery. Most of these are bogus and when we confront them they say "Oh... well then just let us review your case and we should settle payments within a few weeks". Well, then here comes another letter with another reason the next week! I have talked EXTENSIVELY with the insurance coordinator at my clinic and she said she is 100% sure that everything was done correctly with my case because they have had other CIGNA cases come through since my Sx and they have had no problem with their cases.

Honestly... I was in COBRA on my insurance when I had the Sx and I COBRAed just for this purpose! My surgery was on November 28th and My policy ended on November 30th. I have a sneaking suspicion that since I no longer pay them premiums each month as an active policy holder, they no longer feel obligated to pay out this claim. Never mind the fact that I was a policy holder when I had the surgery!

Getting off my soap-box now!

[cindyg1212 0]

I think you may be right that if you were still an active member, they would pay more willingly. Do you pay out of pocket for fills or are you on a new insurance plan? If everything was done correctly, you could register a complaint with the department of insurance for Texas. That's where you had your surgery, right? I found a website that lists how to register a complaint for every state. Click on Complaints and Appeals.

Just scroll down to Texas. Maybe you can get some help. Wouldn't hurt to let Cigna know that if this doesn't get resolved, you will have no choice but to seek help. They won't want the headache. Hope this helps.

Edited July 13, 2008 by cindyg1212

[TxArcher 2]

Gee wiz does the bad news ever stop!

I got in tough with my "new" doctor's office yesterday. (we will see if I ever make it to an appointment with him) I talked to his billing person. She told me that self pay fills are $340:eek: On top of that, he does fills under x-ray at the hospital, so the hospital gets to charge me too! Their "fair-share" is $520!:tongue_smilie::eek:

$860 for a stinkin' fill! Highway robbery! I think I will try talking to my N.P. here at work to see if she is comfortable doing a palpation adjustment.

That wouldn't cost me a penny!

[Shalee04 7]

Sorry to hear your going thru this Tx. I wont complain about my $350.00 fills. I am in the process of tryng to find a Dr out here who will take me on and take my insurance and bill in network. My insurance will cover WLS and fills IF Dr's would just bill in network, But my Surgeon billed out of network and I have had to pay for all his fee's. insurance covered hospital portions. but not any of his. and wont cover my fills becasue of the out of network billing. I even asked them to bill in network and I would pay the difference as it would still be less then the 350.00, but they wont... and trying to find a new Dr to take me out here isn't looking good so far.

I really need a fill but keep putting it off as the $$ is hard to come up with. I pay a little over $400.00 a month for Cobra to keep my great UHC plan I had at work. and I want to be able to utilize it. Sigh

Good luck TX....

[Foofy 0]

Gee wiz does the bad news ever stop!

I got in tough with my "new" doctor's office yesterday. (we will see if I ever make it to an appointment with him) I talked to his billing person. She told me that self pay fills are $340:eek: On top of that, he does fills under x-ray at the hospital, so the hospital gets to charge me too! Their "fair-share" is $520!:embaressed_smile::eek:

$860 for a stinkin' fill! Highway robbery! I think I will try talking to my N.P. here at work to see if she is comfortable doing a palpation adjustment.

That wouldn't cost me a penny!

Good God!!! That's amazing!! I had no idea that people were being charge such high fees. Really, if you knew you might have to pay almost a thousand dollars for a fill, wouldn't you have leaned towards gastric bypass? The whole point of the band is that it is adjustable, but if it costs that much to do the adjustments, it's really NOT adjustable. It would almost be cheaper to fly back to your original doctor for fills. So sorry.

I see that they are doing trials on a new kind of band that constricts and loosens using telemetry (with a tiny motor in the band). It would put an end to fills as we know them.

[TxArcher 2]

I see that they are doing trials on a new kind of band that constricts and loosens using telemetry (with a tiny motor in the band). It would put an end to fills as we know them.

Ha... Next we will have battery changes instead of fills!

I guess there will be Band Mechanics instead of doctors. "Welp, lets look under the hood. Oh yeah, there's your problem... You have a dead battery."

Sorry, I couldn't resist!

Yeah the $800 plus fills are absolutely highway robbery!

believe me... since getting this news, I have had second thoughts on the band. I know it was the right choice for me, but it ticks me off to think there ARE actually people that HAVE to pay that much as a self-pay.

Edited July 16, 2008 by TxArcher