Concerned/Worried/Anxious

[~Sabrina K~ 0]

Hello All! I've been going in circles reading everything I can and finally have the guts to ask/vent.

I started the process in October. I have Cigna as primary and Tricare Prime as secondary. I attended the seminar, did my sleep study, got a referral from my doc, did my labs etc. I got everything in and learned that Cigna clearly has an exclusion. On to Tricare...I've called several times and got several answers, so did my Surgeons office. I had my first appt. today and they seem to be very positive about getting approved. I am 33, am 245 & have a BMI of 45, no co-morbidities that Tricare lists. They did NOT submit my claim to Cigna due to the exclusion, I did NOT do a psych. appt at all and my referral came from my doc that is NOT my PCM. I'm so worried that I'm not going to get approved and will have to start all over. However, they set a tentative surgery date of Dec. 17th.????? Has anyone used Tricare Prime as a secondary insurance? GEESH!!! This has been a process, let me tell ya! I'm so discouraged for some reason, yet it could be because everything always goes wrong for me. Keeping my fingers crossed!

[Swan56 6]

Hello All! I've been going in circles reading everything I can and finally have the guts to ask/vent.

I started the process in October. I have Cigna as primary and Tricare Prime as secondary. I attended the seminar, did my sleep study, got a referral from my doc, did my labs etc. I got everything in and learned that Cigna clearly has an exclusion. On to Tricare...I've called several times and got several answers, so did my Surgeons office. I had my first appt. today and they seem to be very positive about getting approved. I am 33, am 245 & have a BMI of 45, no co-morbidities that Tricare lists. They did NOT submit my claim to Cigna due to the exclusion, I did NOT do a psych. appt at all and my referral came from my doc that is NOT my PCM. I'm so worried that I'm not going to get approved and will have to start all over. However, they set a tentative surgery date of Dec. 17th.????? Has anyone used Tricare Prime as a secondary insurance? GEESH!!! This has been a process, let me tell ya! I'm so discouraged for some reason, yet it could be because everything always goes wrong for me. Keeping my fingers crossed!

Hey! I know how frustrating insurance companies can be... they have hoops and hirdles and all kinds of road blocks. From what I have read (and i don't have any experience with Cigna or Tricare) most insurance companies are pretty good at approval first go round. And if you are denied - they have to give you a reason and then you can appeal it. So you wouldn't have to start all over - just get the information they are lacking to approve you. I wish you luck! TRY to be patient ... i know I wasn't so good at that part

[~Sabrina K~ 0]

Thank you Swan56!!

Well, before I left work today I just was curious and it said "NOT APPROVED". So I called to see what the issue was. Just as I thought, they needed a denial letter from my primary. I told the office this would happen. I am one of those people that like to do things "Just in case". I explained to them that the policy has a direct exclusion for any bariatric procedure and they said to fax that part of my policy over. HOPEFULLY that will be enough or it will be a few days or more to get a denial letter from Cigna. UGH!!!!! Oh well-- I still have a few more dollars to round up anyway as it's out of network and Tri-care should reimburse that part after the procedure.

I love this forum and all the great stories involved. It's great to know I'm not going at this alone and others have similar issues.

[Swan56 6]

Thank you Swan56!!

Well, before I left work today I just was curious and it said "NOT APPROVED". So I called to see what the issue was. Just as I thought, they needed a denial letter from my primary. I told the office this would happen. I am one of those people that like to do things "Just in case". I explained to them that the policy has a direct exclusion for any bariatric procedure and they said to fax that part of my policy over. HOPEFULLY that will be enough or it will be a few days or more to get a denial letter from Cigna. UGH!!!!! Oh well-- I still have a few more dollars to round up anyway as it's out of network and Tri-care should reimburse that part after the procedure.

I love this forum and all the great stories involved. It's great to know I'm not going at this alone and others have similar issues.

I totallly agree - this site is so helpful! Have you checked out any of the member pictures in the Gallery? It's really great to see the before and afters... so encouraging.

Good luck with your insurance stuff! I hope the letter is enough...

[melzie_99 22]

Hello All! I've been going in circles reading everything I can and finally have the guts to ask/vent.

I started the process in October. I have Cigna as primary and Tricare Prime as secondary. I attended the seminar, did my sleep study, got a referral from my doc, did my labs etc. I got everything in and learned that Cigna clearly has an exclusion. On to Tricare...I've called several times and got several answers, so did my Surgeons office. I had my first appt. today and they seem to be very positive about getting approved. I am 33, am 245 & have a BMI of 45, no co-morbidities that Tricare lists. They did NOT submit my claim to Cigna due to the exclusion, I did NOT do a psych. appt at all and my referral came from my doc that is NOT my PCM. I'm so worried that I'm not going to get approved and will have to start all over. However, they set a tentative surgery date of Dec. 17th.????? Has anyone used Tricare Prime as a secondary insurance? GEESH!!! This has been a process, let me tell ya! I'm so discouraged for some reason, yet it could be because everything always goes wrong for me. Keeping my fingers crossed!

Don't know about Tricare Prime as a secondary insurance; they are my primary. I think you should have better results with them; if you have a BMI of 45 then I have to assume you're probably at least 100 lbs overweight which IS one of their requirements...I had a response back from them in less than 48 hours. Plus, if approved, they'll cover you 100% for Prime! Good luck, and let us know what happens!

[~Sabrina K~ 0]

Thanks! I've been fighting with Cigna just for a stupid DENIAL! "Ma'am, it can take up to 30 days" is what they told me today! REALLY, more time and money wasted on something I'm telling you that will happen regardless cause it NOT covered in my policy. SMART INSURANCE COMPANY!!!! I see that you have a date of 1/10/11...Congrats!!!! Did they make you do the psych eval and supervised diet before approval? I heard of some not being required to do it. They haven't told me I need to, but, I've had to switch to Tricare Standard to use the Dr. that I need to.

It's just been a big MESS! Keep us updated on your surgery, you get to enjoy the holidays and start the New Year FRESH!!!!

[bayareanan 24]

Stars,

I was denied in about 2 weeks from Cigna because it was an exclusion, so it shouldnt take that long.

Thankfully my insurance changed this year and it was covered.

[melzie_99 22]

Thanks! I've been fighting with Cigna just for a stupid DENIAL! "Ma'am, it can take up to 30 days" is what they told me today! REALLY, more time and money wasted on something I'm telling you that will happen regardless cause it NOT covered in my policy. SMART INSURANCE COMPANY!!!! I see that you have a date of 1/10/11...Congrats!!!! Did they make you do the psych eval and supervised diet before approval? I heard of some not being required to do it. They haven't told me I need to, but, I've had to switch to Tricare Standard to use the Dr. that I need to.

It's just been a big MESS! Keep us updated on your surgery, you get to enjoy the holidays and start the New Year FRESH!!!!

Tricare doesn't require a psych eval or a supervised diet (at least not Prime), but your individual surgeon might. I had a roughly 5 minute psych eval with a LAC and the only diet I have to do is the 2 week one presurgery. Thanks for your well wishes; I'm looking forward to taking a step in the right direction FINALLY.