Insurance Approved, Now after Lapband Cigna will not pay

[Angel76 0]

Received Precertification letter from Cigna with approval code stating that surgery was medically necessary and a covered benefit on 10/12/10. Had lapband surgery on 10/27. Now I'm in the 2nd appeal stage to get Cigna to pay my surgeon and hospital bills ($17,000 worth!!). How in the world can this be possible? Does anyone know what my next step should be if the 2nd appeal is denied? Has anyone ever had this happen to them. Should I hire a lawyer?

[CIGNAQuestions 0]

Received Precertification letter from Cigna with approval code stating that surgery was medically necessary and a covered benefit on 10/12/10. Had lapband surgery on 10/27. Now I'm in the 2nd appeal stage to get Cigna to pay my surgeon and hospital bills ($17,000 worth!!). How in the world can this be possible? Does anyone know what my next step should be if the 2nd appeal is denied? Has anyone ever had this happen to them. Should I hire a lawyer?

It doesn't sound like the claim(s) have been processed correctly. I would like to help you with this. Please send me your contact info to SCR_isolve@cigna.com if you would like my assistance. Hopefully we can figure this out together!

[collins33 2]

I agree with the last post because I have Cigna and they paid for everything after I met my deductible. Now for the fills, I have to pay as an out patient. Sorry about your struggles.

[hopeful one 86]

Received Precertification letter from Cigna with approval code stating that surgery was medically necessary and a covered benefit on 10/12/10. Had lapband surgery on 10/27. Now I'm in the 2nd appeal stage to get Cigna to pay my surgeon and hospital bills ($17,000 worth!!). How in the world can this be possible? Does anyone know what my next step should be if the 2nd appeal is denied? Has anyone ever had this happen to them. Should I hire a lawyer?

[hopeful one 86]

Hello, This happened to my daughter and she had 100% coverage and when the bills came someone had coded them wrong and slowly but surely they are getting paid, she still has the big one hanging in the air but fingers are crossed. Good Luck.

[Darkkmocha 5]

You surgeon or hospital must be billing it incorrectly. If the diagnosis code and/or procedure codes are incorrect, that will make the claim deny.