Appeal With Cigna?

[BABEwiththePOWER 16]

So about 2 months into my journey, I submitted all the required paperwork to Cigna. They require a 6 month, monitored weightloss program within the past 5 years. I submitted my weight watchers paperwork from before my first pregnancy about 4 years ago, knowing it was highly unlikely they'd accept it. But, I thought there was no harm in trying, since my dr wrote a great letter about how she's been on this weight loss journey with me for years, and cited several weights, etc.

Well, I was denied. My surgeon even had a peer-to-peer review with the insurance person, and couldn't convince him. The insurance guy said we had to have 6 months of dr supervised weight loss counseling, where we weigh-in once a month.

So, I've just finished my last month of weigh-ins, and was excited to re-submit a claim. Well, the dr's admin told me it's actually considered an appeal, since we're making the same claim with different info. She also said it could take up to a month!

We have a tentative surgery date of April 2nd, and I'm thinking we're cutting it kinda close. But, that's the only time my hubby could take off work to help out, so we're basically forced into that timeframe.

My question is, is there anything I can do from my end to help speed up the process? The appeal was submitted 2/15. My surgeon's office is handling it all, but I'm kindof in the dark, and wonder if I should call Cigna myself, or what?

Has anyone else been through this? Any ideas?

Thanks!

[teambrown4 19]

I am NOT trying to discourage you... Just sharing.... I went through the same thing with Cigna(open access plus), and after all was said and done they still denied my appeal after the 6mo and all paperwork from dr saying I needed it!

They said jut because my BMi was higher than their minimum, I didn't have a "health risk", stating diabetic & high blood pressure.

My response included the fact that I'm next in line for those things and my medical will be used for sure for a very long time for care and even heart and cholesterol issues and so so on...

Another month went by and another denial!

My resolution was a $20k medical loan and my sleeve was done 2-13!

At some point (2years), I had to bite the bullet and take care of what I knew I needed!!!

Now... I hope hope hope your outcome is successful. And if not that you have options!!!

Just wanted u to prepare...

Good luck!!!

[BABEwiththePOWER 16]

Thanks for your honesty teambrown... I do hope it goes better for me, since we're doing exactly what the medical reviewer told my surgeon I needed... but who knows!

I am prepared to self-pay, but obviously, I'd rather have insurance pay the 15K if at all possible. I don't think I'll let a denial stop me, or make me wait. I need to do this NOW.

thanks again, and I'll keep you updated =)

[momof4 10]

Yeah I was at the point that after I cried a minute I said... Too bad... I must do this! Least yours is 5k less then mine! but I live by the beach so it's a douchey hospital-lol... My surgeon was higher than two others I met with but I didn't feel the instant click with them I did with mine! So that was worth it when asking someone to cut into on onto me!!! Ya know??? serious good luck!!!

[massindex 346]

I was denied on final approval after Cigna had tentatively approved it. I filed the appeal and it was denied also. I ended going the self-pay route in Mexico and never regretted it.

[BABEwiththePOWER 16]

Argh. I have been so pleased with Cigna up to this point, I really hope there's some hope for me...sounds like that's not the norm though

Has ANYONE had luck with Cigna appeals???

[bella143 8]

Hi.. I also have Cigna. Ive completed my 6 months and have everything in order. My insurance navigator submitted everything to Cigna early feb. I originally had a surgery date for feb 15 and that got pushed to the 29 (tomorrow). I still haven't gotten an approval or denial. I called Cigna myself last week and they were a little rude, telling me they can't do anything Ro speed up the process and it can take up to 45 business days for an answer! I'm now prepairing my self for the worst. I've heard Cigna is tough! I too have no other medical condition like diabetes etc.

My doctors office said I will be fine and will get approved but I don't know anymore. I hope you have better luck!

[HopeThruFaith 30]

BabewiththePower, are you using the same surgeon that submitted the weight watchers documentation?

[BABEwiththePOWER 16]

BabewiththePower, are you using the same surgeon that submitted the weight watchers documentation?

I am using the same surgeon. He submitted my WW info with the rest of the documentation the first time around about 3 months into our 6 month journey. I was seeing him monthly anyway as a precaution. He had a peer-to-peer review with the medical reviewer at Cigna, and was told I would need the 6 month check-in to be approved.

I called Cigna myself today to see if I could get a status update on the review, and they said it was pending dr review on the Cigna side. The lady I spoke with was very nice and optimistic, saying they do their best to get these turned around asap for people. She didn't speak to a 45 business day timeline or anything like that, so we'll see...

staying hopeful