Radwilk

I spoke to the head of HR for my company and she contacted CIGNA on my behalf. Apparently I am not the only one with this problem right now. CIGNA acknowledged that they are failing to notify patients or doctor's of their requirement that the surgery must be done at a CIGNA approved COE. In the denial letter it says denied due to the fact that hospital X is not a Bariatric Surgery Center of Excellence. When in fact my hospital IS a COE just not a "CIGNA" COE. Even the denial letter is not specific enough to say that they don't just mean a COE but a "CIGNA" COE which there are none within 200 miles. Today when I called CIGNA to ask where I could have my surgery they gave me the wrong information yet again and told me my hospital is on the list of acceptable facilities. This is not my mistake it is CIGNA's and I don't understand what else I could have done to make sure I was seeking services from a surgeon affiliated with a hospital that they approve of. Ultimately I just want to have the procedure I need, but I am terribly uncomfortable driving 4 hours away and not receiving the follow up care that I need. If I were to have surgery in Houston and be discharged home and had a complication at home I could not call my doctor and have him meet me in the local ER. That is a huge risk that CIGNA is forcing me to take. I am so frustrated, but I am not giving up. I am considering having a bariatric advocate handle the appeal for me. Has anyone ever done anything like that? What can I expect?

Today while recovering from my upper GI I received a call from the insurance coordinator at my surgeon's office. She informed me that I had been denied for my surgery next Tuesday due to the fact that the surgery was taking place at a hospital that is not a bariatric center of excellence. From the beginning of this insurance process in January I have communicated with CIGNA several times regarding my surgery and the steps I had to take for approval and NEVER has this been mentioned as a requirement. The coordinator has spoken to CIGNA several times regarding the criteria and CIGNA did not inform them that I had to have the surgery at a BCE. Aside from the problem that I really like my surgeon and have been with him and his staff since February there are no BCE within 200 miles of my home. Even when I called the preauth dept, benefits dept, and a few other departments at CIGNA today not once did I get the same answer about where I could have my surgery. I am so devestated. I don't really know if anyone has had this same experience, but if you have please let me know. I would like to appeal, but I want to make sure I do it right.

I have CIGNA too and my Dr's office submitted yesterday. They said it usually takes a few days to hear back from CIGNA. I have heard it took weeks from others, but I guess the Dr's office knows best. Supposedly the coordinator at my doctor is going to call them tomorrow, which will mean CIGNA will have had my info for only about 2 days, and ask for expedited approval. My surgery is scheduled for Tuesday, July 31st. Has anyone else heard back from CIGNA this quickly? I don't want to change my surgery date, but they couldn't send out my packet before this week due to test results etc. I did gain and lose throught the supervised diet program. However, when I started I was below my norm. Now during the preop I am sure I am losing a few lbs. My BMI is 36.

I have CIGNA OAP as well. I was wondering if CIGNA considers GERD a comorbidity? This is the only comorbidity that I have current documentation of having an offical dx. My BMI is 35-36. I have completed 5 months of the formerly required 6 months nutritionist supervised diet (its now 3 months). I have completed the psychiatric evaluation. I have had a few visits with my surgeon including the initial consult and a couple of follow ups. Now I am just prepping myself to visit with my PCP, which I am nervous about. I don't know if I have other comorbidities. Of course my knees, hips and back all hurt. My left foot has had 2 stress fractures. My blood pressure has increased by about 20-30 pts, but it was actually VERY low when I wasn't this overweight years and years ago. The top pressure was under 100 most of the time. So I don't see that I have HBP exactly. I haven't been tested for sleep apnea, pulmonary hypertension, hyperlipidemia (sp?) etc. I guess I just don't know where to start with the comorbs. I feel terrible all the time so something isn't right. I have avoided doctors for a while because I know they would tell me to "just lost weight and you will feel better" and I couldn't keep the weight that I lost off. UGH. Sorry to unload, but I am so nervous that I will be denied.