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Surgeon & Cigna... Peer to Peer Phone Review?

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Started by Shelby, Feb 27, 2007 4:19 PM
17 replies to this topic
17 replies to this topic

    Shelby

    Senior Member

  • Posts: 76
  • Joined: Jan 2006
  • Surgery: LAP-BAND
Posted February 27, 2007 - 4:19 PM

#1
Has anyone had to do this??

Cigna Authorization Dept wants to have a Peer to Peer phone conversation with my surgeon so they can discuss what additional information needs to be provided by my surgeon or myself.

Quick recap: I was denied a few wks ago because of 6 month doc visits which was completed and submitted. I called Cigna to find out exactly what was missing and after talking to 4 people (on the phone 1 hr 50 mins) they told me I submitted everything and it's all documented.

Not sure if this is normal request or if they just didn't have an answer for me so and this request would get me off the phone. Although the folks I was talking to today were wonderful! Finally - someone who actually was trying to answer my questions.


    emadrak

    Novice

  • Posts: 16
  • Joined: Feb 2007
  • Surgery: LAP-BAND
Posted February 27, 2007 - 7:53 PM

#2
I have cigna insurance too. I am just starting though. I haven't gone for my visit w/my surgeon yet. I was also wondering what info they wanted exactly. I went to my doc in 2005 and over the process of six months had been followed by my doc. So, am I supposed to have the doc copy those notes for me and bring them with me? Do you have to have an endoscopy and colonoscopy for the surgery, for Cigna? Has anything changed since you last wrote, did you get approval? Sorry I can't give any answers to you?
:)


    wanabethin

    Senior Member

  • Posts: 73
  • Joined: Feb 2007
  • Surgery: LAP-BAND
Posted March 2, 2007 - 6:54 PM

#3
Any news? I'm courious b/c I have Cigna too, my file was submitted last week, and I'm watting for a response. I called and they say it's going to take like 3 wks. I need to call back on the 23rd. :)


    Shelby

    Senior Member

  • Posts: 76
  • Joined: Jan 2006
  • Surgery: LAP-BAND
Posted March 5, 2007 - 4:46 PM

#4
My surgeon and Cigna are playing phone tag - it's been a week now. I'm hoping this can be resolved within the next few days! So the saga continues :-)

I didn't have to take a colonoscopy or an endoscopy - maybe that could be a requirement from your surgeon prior to surgery.

And... this hurts.... but in my experience Cigna takes the full amount of time to respond. Cigna's 30 days is actually 30 business days! It's painful waiting that long!

Thanks for your responses - I'll let you know as soon as I hear something!


    wanabethin

    Senior Member

  • Posts: 73
  • Joined: Feb 2007
  • Surgery: LAP-BAND
Posted March 5, 2007 - 10:50 PM

#5
I wish for you to get your approval soon. Keep me update, by the way in what state you live? I live in Texas and I don't know if it is different in other states.


    Shelby

    Senior Member

  • Posts: 76
  • Joined: Jan 2006
  • Surgery: LAP-BAND
Posted March 6, 2007 - 6:15 PM

#6
I live in Texas too. Keep calling Cigna for updates - not all Cigna Reps are very helpful but every once in a while you get someone who seems like they are really trying to help. Good Luck to you - let me know when you hear something.


    wanabethin

    Senior Member

  • Posts: 73
  • Joined: Feb 2007
  • Surgery: LAP-BAND
Posted March 27, 2007 - 6:43 PM

#7
Cigna apprved my surgery, I still don't have a date, hopefully tomorrow I will know.


    wanabethin

    Senior Member

  • Posts: 73
  • Joined: Feb 2007
  • Surgery: LAP-BAND
Posted March 27, 2007 - 11:43 PM

#8
Celebrating!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!:Banane03: :Banane21: :clap2: :update: approved, appoved, APPROVED!!!:clap2: :clap2: :clap2: :clap2: :clap2: :peace: :teeth: :amen: :whoo: :whoo: :whoo: :whoo: :whoo: :whoo: :whoo: :whoo: :whoo: :bump2: :gluck: :love: :bananapartyhat: :Banane14: :shade: :bananajump: :Banane10: :wow2: :laugh :pop2: :Banane35: :boxing: :lock1: :thumb: :wave: :hititbanana: :yo: :banana :bounce: :music: :yo: :) :P


    Shelby

    Senior Member

  • Posts: 76
  • Joined: Jan 2006
  • Surgery: LAP-BAND
Posted March 28, 2007 - 1:50 PM

#9
Congratulations Wanabethin!!! I'm very excited for you! Do you have a surgery date yet? Who is your surgeron?

My Update: Cigna gave my surgeron the run-around and they never connected via phone. The office referred me to Walter Lindstrom (ObesityHelp.com Atty) and he has accepted my case! Walter will submitt the paperwork for an appeal. He doesn't take any cases he can't win so hopefully he'll be able to help me! I'm so grateful for his help.


    wanabethin

    Senior Member

  • Posts: 73
  • Joined: Feb 2007
  • Surgery: LAP-BAND
Posted March 28, 2007 - 4:53 PM

#10
Surgery date is April 4, next Wednesday. My surgeon is Dr. Carter, he is in Arligton. I'm going tomorrow for pre-op tests and talk to surgeon. Good luck with your appeal, is good to know that your lawyer is going to win this for you. Keep me update, I will let you know about the whole process so you can get ready. Thanks and good luck;)


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