Cigna Conflicting Answers

[Soli3l 30]

Good morning:

June 2012 the doctor suggested that due to a Slipped band and my diabetes and unsuccessful weight loss, I remove the band and get a Gastric Sleeve.

June 2012 - CIGNA approved removal of the Lap Band, but denies the Gastric Sleeve. Reason: There is no documentation I followed Diet/Exercise Program.

July 2012 - My doctor submitted paperwork again and got denied.

September 2012 - Doctor gathered the 6 month Diet/Exercise documentation showing I followed the protocols, but due to my Diabetes and Slipped Band my weight loss have been unsucessful.

The doctor said he would appeal the decision and resubmitted the paperwork to obtain authorization, they would contact me with the decision and surgery date. They submitted the Appeal and Insurance person confirmed CIGNA received it.

I have been calling CIGNA to get a response to the Appeal and I get conflicting information:

• CIGNA says they have not received any appeal, the doctor has to resubmit.
  
• Appeal was denied
  
• Appeal was approved but there is a discrepency.
  
• Appeal was voided.
  
• Appeal was received, but is still under review no decision has been made.
  
  • CIGNA says a decision would be made on 10/8/12 to call them that day
    
  • Another says it takes 30 days for a response.
    
  • CIGNA rep says it takes 45 days for a response.
    

It seems everytime I call I get a different response. WHY???? What is the dept I need to talk to? I've spoken with Appeals Department, Precert Department, Provider Services. This seems frustrating.

Thanks for reading.

Soliel

[IsB 209]

Good luck. Dealing with insurance companies is never easy. I wish there was some sort of way to get in touch with a person who knows something but there never seems to be. You're going to have to just keep plugging away and have your doctors office do the same thing. The doctor doesn't get paid unless they get this approved. It's in their interest to help too. Keeping hitting both.

[ButterflyAMT06 9]

I feel your pain. I was back and forth with Cigna for about 2 months. My doctors office submitted paperwork on August 2 and i was denied the same day because the hospital my surgeon works with Cigna doesn't see them as a 3 star center of excellence for bariactrics and they are dual certified. So we tried to show them that they were but Cigna said no and they only approve one hospital here in Houston so we had to change the hospital on the paperwork and luckily my surgeon has privileges at the hospital or I would have had to transfer all my paperwork to a surgeon who works with that hospital. So we resubmitted the paperwork with new hospital and I was approved within 5 days surgery on October 29 but during those 2 months i called everyday to Cigna and I too got different answers and I hated having to repeat my story each time and Each time I called I told them every rep gives me a different answer and I need to talk to someone who can help me sort through all of the crap you are telling me and i did i called several times a day until i got someone who helped me out and we were on the phone together for about 40 mins. i was on hold most of the time but she would go back and forth until she found out what the problem was and after that i called back the next day several times to check and yep finally the reps were giving me the same answers. So don't give up call, call, call until you are satisfied. Good Luck

[Soli3l 30]

Thank you both for the input...yes I am still calling Cigna...now they say they haven't even received the appeal.

[Soli3l 30]

Ok, so after calling every day (multiple times a day), I spoke to the first Male Coordinator whom assisted me with correct info, he couldn’t transfer me to the Precert Dept, so he gave me the number (this is for Providers). They assumed I was the provider, stated the surgery was approved and requested I give the fax number so they could fax it over. At this time, I gave them the doctor's fax number and they sent it. When I called to get an additional copy, I was told that they don’t fax, they transferred me to the appeal's department, whom said surgery was approved but it takes 3 – 5 days to receive the fax. I then called my doctor’s office, they received the approval today, (because of all the leg work I did) and they will be calling me shortly to coordinate the Surgery. ***FINALLY APPROVED and IT HAS NOT HIT ME YET***

[ButterflyAMT06 9]

Good for you!!!! Yep that's what I had to do the leg work lol and i found out i was approved before my doctors office. I read somewhere on this forum that you have to be your own advocate and I figured my coordinator is working with so many patients trying to get them approved and I was already denied once so I didn't want to wait around any longer. I hope you find out your date soon and post when you do. ???? Alicia

[ButterflyAMT06 9]

Ddeo3= i was trying to do a smiley face from my iPhone but I guess you can't lol

[Soli3l 30]

Thank you Butterfly, I am having the band removed 10/18 and then I have to set up another date for the Sleeve, I am uncertain how long I have to wait. I was advised that the hospital I am going to no longer allows the lap band to sleeve revision in 1 surgery. I will sure ask why on Monday for Preop Visit.