CIGNA people-How long did it take for approval/denial?

[kacee 3]

I have CIGNA. My paperwork was submitted April 19. There is still no word. The doctor's office said they had 30 days but usually when they deny it's within the first week or two. I'm interested in knowing if you were denied, how long before you got that word, and if you were approved, how long for that? My surgery is scheduled 5-23 and we're getting down to the wire here....

[Alexandra 55]

You should call Cigna on Monday and see what their timeframe is for responding. Your doctor's office is correct, denials usually come fast. In most states the law calls for quick turnaround on requests for precertification; though 30 days is typically the max it shouldn't ever take nearly that long.

Call! Make sure they have all the pieces they need to render a determination. The worst thing would be for them to call you or your doctor on the 21st or something just to say they don't have all the information they need. April 19th seems like too long ago for there to have been no response at all.

[kacee 3]

Thanks for the response! I was kindof thinking it had been quite a while for a denial to be coming through. I'll give them a call on Monday.

[tanderson 3]

My approval decision took 2 1/2 weeks from the time Cigna received the paperwork.

Peace Out!

T~:hippie:

[Shelby 0]

For me Cigna took the full 30 'business days' to deny me. Call and call again and again. Only twice was I able to get past the first line of customer service reps (and I've been denied 3 times). There are some reps that will help you - others are just reading the notes from the screen in front of them. Keep calling! Good Luck!

[Joaquin 0]

For me Cigna took the full 30 'business days' to deny me. Call and call again and again. Only twice was I able to get past the first line of customer service reps (and I've been denied 3 times). There are some reps that will help you - others are just reading the notes from the screen in front of them. Keep calling! Good Luck!

I have Cigna also and I was wondering if they tell you why you were denied? Did you have to do the six month diet? Hopefully I am not asking too many questions.

[Shelby 0]

This is a great place to ask questions! My first denial was because the surgeons office submitted my paperwork before I completed all of Cigna's requirements (yup!). So that was a no-brainer denial. I was denied the 2nd time for the Gastric ByPass surgery - yeah - scrary huh? When I called Cigna regarding this they said I should not have followed the instructions on the 1st deniel letter and included the letter. Who knew? Then I found a new surgeon and they submitted everything to Cigna (w/o denial letters) but was denied because of something to do with my 6 month doc visits. I say 'something' because I received a 2 page letter that I just could not understand! Seriously - when I called Cigna they couldn't explain it to me either! And that time I actually talked to 4 people and no one could explain it! They suggested my surgeron and their Director of Medicine talk about my case. My surgeon called 4 times before he gave up. He was never able to reach the Director of Medicine. He was told he was given the wrong number to call, was put on hold for 20 mins at a time, etc. I was then referred to Walter Lindstrom who accepted my case and I'm now waiting for him to submitt an appeal.

Sorry so long winded - it's just so frustrating when it all seems to be administrative issues. I meet the criteria, I've completed what was required by Cigna, my policy covers Lapband (no exclusions). It's just crazy! Guess Cigna is hoping I'll go away but I'm not!

Hang in there! Keep calling. If you get a rep that is not so helpful - hang up and call back. I was only told the reason of denial after the denial letter had been mailed to me. Guess that way I'd have to re-submit and wait an additional 30 business days. Just my guess.

I hope I didn't scare or discourage you! Keep the faith! What's meant for us won't go by us!

[michiganer 0]

I also have Cigna and would love for more Cigna people to respond. Right now I am in month 5 of my nutritionist diet program thing. I have an appointment set with my doctor to get a letter of medical necessity and my insurance covers lap band. I would be devastated if after all this, I get denied. I am praying that once all of my paperwork comes together, Cigna will approve it for me. Any other out there with good/bad Cigna stories?

[tanderson 3]

I also have Cigna and would love for more Cigna people to respond. Right now I am in month 5 of my nutritionist diet program thing. I have an appointment set with my doctor to get a letter of medical necessity and my insurance covers lap band. I would be devastated if after all this, I get denied. I am praying that once all of my paperwork comes together, Cigna will approve it for me. Any other out there with good/bad Cigna stories?

I was just as nervous as you are about being denied. The insurance lady at my surgeon's office told me that if you meet ALL of their requirements, i.e. 6 month diet, nutritionist appt., psychiatric eval, letter of medical necessity, that they will usually approve you on the first try. And that is exactly what happened to me. I got my approval in 2 1/2 weeks! Good luck!!

[michiganer 0]

Wow thanks Tanderson! I am getting everything together so I should have everything they ask for. I am hoping to submit everything in about a month. My last Nutritionist appt is July 25th I think so as soon as that is done-Its GO time!

[bfyneNtyme 0]

I also have Cigna and would love for more Cigna people to respond. Right now I am in month 5 of my nutritionist diet program thing. I have an appointment set with my doctor to get a letter of medical necessity and my insurance covers lap band. I would be devastated if after all this, I get denied. I am praying that once all of my paperwork comes together, Cigna will approve it for me. Any other out there with good/bad Cigna stories?

I have many friends who were denied by Cigna so before I applied I did my homework. What I found out is you MUST submitt all the necessary paperwork at the same time to avoid getting denied. The 2 things that Cigna requires is a Psy Eval and diet program. The upside is if you've been overweight for 2 plus years and have tried to loose weight but was unsuccessful or lost only a minimum amount of weight, that is acceptable to send in. The 6 month step is just a "front" by Cigna! I was not on a 6 month program but over the last 5 years I had been successful in loosing 90 lbs by dieting and exercising. Once I hit my plateau I applied for the Lap Band with Cigna. I started May 9th and was APPROVED on June 14th. I'm ecstatic and can't wait until July 2nd which is my surgery date! Key pointer for Cigna...send both requirements in at the same time. The call, call, and call again!

Good Luck!

[michiganer 0]

Congratulations! So far I have 2 more visits with the nutritionist and I am going to my regular doctor in July. He said he would write me a letter of medical necessity if I went to a Cardiologist and was cleared. I did that and the heart is good. So now I just need to tell my regular doc and he will give me the letter. I am also getting a letter from my endocronologist. I figure the more doctors on my side, the better. Then I need to find a person to do the psych eval. I am hoping to find one that takes insurance and hopefully Cigna will pay for some of it. We shall see...

[Mischievous1 6]

I have many friends who were denied by Cigna so before I applied I did my homework. What I found out is you MUST submitt all the necessary paperwork at the same time to avoid getting denied. The 2 things that Cigna requires is a Psy Eval and diet program. The upside is if you've been overweight for 2 plus years and have tried to loose weight but was unsuccessful or lost only a minimum amount of weight, that is acceptable to send in. The 6 month step is just a "front" by Cigna! I was not on a 6 month program but over the last 5 years I had been successful in loosing 90 lbs by dieting and exercising. Once I hit my plateau I applied for the Lap Band with Cigna. I started May 9th and was APPROVED on June 14th. I'm ecstatic and can't wait until July 2nd which is my surgery date! Key pointer for Cigna...send both requirements in at the same time. The call, call, and call again!

Good Luck!

wow, this is good information that you for sharing, I hate that they make us jump through hoops....

[bfyneNtyme 0]

Congratulations! So far I have 2 more visits with the nutritionist and I am going to my regular doctor in July. He said he would write me a letter of medical necessity if I went to a Cardiologist and was cleared. I did that and the heart is good. So now I just need to tell my regular doc and he will give me the letter. I am also getting a letter from my endocronologist. I figure the more doctors on my side, the better. Then I need to find a person to do the psych eval. I am hoping to find one that takes insurance and hopefully Cigna will pay for some of it. We shall see...

Hey..I just got your message. There are a few things I would like to share with you as you press forward. During my experience with Cigna, I've learned alot. I typed a letter up for the Hospital in which will be performing my surger and I'll send it to you. Cigna does cover the Psy Eval and everything else that you need! The key is to have all your ducks in a row before submitting the paper work to them. I'll send you the process took and how to get approved shortly.

Best Regards!

[bfyneNtyme 0]

My experience with Cigna Insurance and the Quest for Lap Band approval. I want to first give all thanks, praise and honor to God who has delivered me from my misery. I have learned quite a bit about what to do and what NOT to do when applying for coverage with Cigna. I hope that this note can be of help to the many who seek Lap Band Approval. My experience in getting approved for Lap Band Surgery. I first contacted my PCP (Primary Care Physician) and made an appointment to meet with her to discuss weight loss procedures. She agreed that the Lap Band was one of the safest techniques out there so we moved forward. She then asked me to find a Doctor who performs the procedure and do my re-search to check the credentials and success. I then went on line and located a Dr in my area.

I gave her his name and she type up a referral letter so I could present it to his office. I called his office to inquire as to what steps I needed to start for the surgery. I was told to attend a Seminar to see what the Lap Band was all about, etc so I did. After the Seminar I called the office the following work day and was told I needed to set up a Consultation. At the consultation he took my weight, height, blood pressure, heart rate, etc and talked to me about dieting, weight loss and the procedure. He then told that I would need me a series of tests prior to being qualified for the surgery. There are several tests such as an Upper G.I., Eco, Stress test & Psychological Evaluation. Once I completed those test the Dr's office faxed the information to Cigna. I did not hear from Cigna so after about 5 days and I called the Dr's office to see if they had heard any news. They did not and the Receptionist encouraged me to call Cigna to see what status my paper work was in.

I called and they asked me to call back in 7 days, so I did. Cigna said they needed more information but refused to tell me what information they needed over the phone. So the Rep stated that they would send it to me and the Dr's office via "snail mail". After 7 days neither of us had received the letter. I called back and told the Rep that we had not received the letter and due to time constraint I needed the information today! The Rep told me that she could not give me the information over the phone and I immediately asked for a Supervisor.

She transferred me, I remained calm in advising the Supv. that I had not received the letter and needed to know what information they were still needing. The Supv then advised me that they did not receive the Psy Eval (we did fax it) and they also needed a letter from my PCP of my diets, weight-loss, gain etc.

I had not presented them with a letter of weight loss from my PCP so I called and asked if she would type something up for me. Although I had not been on a 6 months diet program, I did have 5 years of weight loss on file. I did not go on Weight-watchers, Jenny Craig, etc but I did do the Atkins Diet in which I managed to loose 88 lbs. My PCP type a very generic letter stating my weight loss, disciple, determination, etc. This was not at all what they asked for because I had not been on a supervised 6 month diet per say, but I was successful as loosing the 88 lbs on Atkins and working out. I was a bit nervous when I read the letter from my PCP, but she only stated the truth and that's what we went with.

When I presented the letter to Dr's office the Receptionist read it and said "well it's different but we will send it anyway". "Cigna is tough and they usually require documentation stating the different diets, weight loss and/or weight gain with each diet". I then told him that this is all I have so let's go with it. Since they asked us to re-send the Psy Eval he faxed it over again with the letter on a Monday. I called them on Tuesday to confirm that they had received the fax and they did. At that time they advised me that it would be a 48 - 72 hour turn around before the office that I was speaking too would have it. So I called back the next day on Wednesday and they had not received the paper work from the other department but asked me to check back later.

I called back on Thursday to see if they had received it in their office and also to see if I was approved or denied. The Rep told me I would receive a letter advising whether or not I was approved or denied. I told her that I've never received anything that they said I would and demanded to speak with the department who makes the final decision. After giving me the run around she finally transferred me to the Pre - Determination department.The Representative from the Pre - D department then asked me to hold, she came back and said we have the paper work in office and you are approved! I couldn't believe my ears! I asked her if she was sure and she said yes.

I immediately hung up and called Dr's office and spoke with John. By this time he knew my voice and said "hello, what's going on", have you heard anything? I said "praise God...I'm approved! He then asked me to call Cigna back to get them to fax a "Authorization Letter" which would have the Authorization number on it. I called back and Cigna said they could not give me the number over the phone but would mail it. Once again I had to bypass the first Rep and ask to speak with the Pre-D department. Once getting through the Rep in Pre-D pulled my chart and gave me the Authorization number over the phone. She stated that they would mail a letter to me and the Dr's office. The most important thing was getting the Authorization number even if we didn't have the letter yet.

When I called John back with the Authorization number, we both started laughing in total dis-belief. I do not have any illness that Cigna requires for this surgery. So much was going against me but I stayed on my knees trusting in God. I had a 37 BMI, no high blood pressure, no diabetes, etc. I am as healthy as can be but because of my height 5ft 1 inch and 196 lbs, I am 75 lbs overweight. That was my only leg to stand on regarding health issue was the 75 lbs overweight. I do believe the 88 lb weight loss worked in my favor over the 5 years that I had been dieting. I did not loose any weight the last 2 1/2 years and that is why I began to see medical help.

I started this journey on May 9th , 2007 and I was approved on June 14th, 2007. To say the least I was ecstatic! There are some very important things I learned in this Quest for a new beginning. First, have all your ducks in a row before submitting paperwork to Cign or they will quickly deny you! Secondly, seek a good Dr. who is persistent in following up with you to see if the Insurance Company has contacted you. Thirdly, you must be proactive in following up for yourself call, call and call again! I cannot stress how important it is to have ALL your documents faxed on the 1st go round. Then, you must call, call, and continue to call. It is annoying to continue calling but if you do not call over and over, your chances of getting approved is very...very slim! Another key is bypassing the first Representative and being transferred to another department who can give more concrete information.

God will deliver those who trust and believe in Him. Don't give up!

Warmest Regards,