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CIGNA ins...help....what does this mean?

peacheeie

By peacheeie, in Gastric Sleeve Surgery Forums

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peacheeie    14

peacheeie
Posted

OK...any input would be great!! Long story short, band removed 9/19 due to erosion, CIGNA insurance, paperwork submitted 10/23 for "band to sleeve revision", called CIGNA on 10/24 and was told that "all my paperwork is in the hands of the medical director and they did not request any more information"! I was told I should have a decision tomorrow..here is my question...anyone think its strange to NOT have them ask for any more information? I am happy, yes, but I do know my BMI is at 33 with a few issues (HPB, RA, digenerative disk disease). Has anyone had this happen too them where they are not quite at the required BMI number & revised with issues? Im thinking they are looking at my paperwork and saying that Im not heavy enough so "denied" or I have so many issues and it is a revision that they look at it and say "approved"!! I know, I know...time will tell and I guess we just live in a world where one tends to freak out because its not complicated enough!! Any insight would be great! Thanks, its going to be a long 24 hours!!

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LSF    264

LSF
Posted

I have Cigna - because you have a medical complication - I don't believe they need anything else. Because I'm looking to have the revision due to band failure (not to mention it' causing me acid reflux) - I have to start from scratch - 90 days and meet with nutritionist, psychiatrist etc..I'm pissed because me insurance plan is changing with Cigna after the new year where right now they will cover 90% and after 1/1 it's only 80% and I won't hit my 90 days until 1/1/15.

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peacheeie    14

peacheeie
Posted

Well, it's official...I was denied!! Apparently, I have not gained enough weight for CIGNA to approve my revision surgery:( I'm disappointed but knew they were going to do this. Apparently, my surgeon is going to have a "peer to peer" with the medical director this week. I remember having to fight so hard with my insurance at the time for the initial lapband surgery but I did it and I have faith I will do it again!!

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LSF    264

LSF
Posted

Good luck - keep us posted

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newstartme    24

newstartme
Posted

Well, it's official...I was denied!! Apparently, I have not gained enough weight for CIGNA to approve my revision surgery:( I'm disappointed but knew they were going to do this. Apparently, my surgeon is going to have a "peer to peer" with the medical director this week. I remember having to fight so hard with my insurance at the time for the initial lapband surgery but I did it and I have faith I will do it again!!

I have Cigna and i am having a revision. Like you, i had the same issues and don't be surprise if you get denied. But do not get discourage. Go to their face book page send them a disappointment anger frustrated letter"calling for help" and they will assign someone to help. File all the appeals, learn your policy and find A loop pool. If there is one that you believe you can fight file an appeal with your state insurance board make as much noise you can. The point is to find a reason of why they should not denied it. Talk to your pcp you will succeed. Good luck

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LSF    264

LSF
Posted

Well, it's official...I was denied!! Apparently, I have not gained enough weight for CIGNA to approve my revision surgery:( I'm disappointed but knew they were going to do this. Apparently, my surgeon is going to have a "peer to peer" with the medical director this week. I remember having to fight so hard with my insurance at the time for the initial lapband surgery but I did it and I have faith I will do it again!!

. Any new info since your last post?

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peacheeie    14

peacheeie
Posted

I was approved, I was approved!!! Date set now for jan 9th!! I would have loved it before years end cause I have met all my deductibles, but I would pay double I'm just so happy to have a new beginning in my sights...again!!!!

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LSF    264

LSF
Posted

Congrats!!! I'm pissed because if I didn't have to wait the 3 months it would cover 90% of the surgery. After the new year, my coverage is changing to just 80% coverage

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Gendy    27

Gendy
Posted

Peacheeie - My sleeve is scheduled for 1/7/15. We can be surgery buddies since our surgeries are so close together. Like you, my deductible was met this year and I'll have to pay a new one next year, but my deductible went down $500 next year, so I still won't have to pay as much. Good luck to you.

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peacheeie    14

peacheeie
Posted

Peacheeie - My sleeve is scheduled for 1/7/15. We can be surgery buddies since our surgeries are so close together. Like you, my deductible was met this year and I'll have to pay a new one next year, but my deductible went down $500 next year, so I still won't have to pay as much. Good luck to you.

ABSOLUTELY!!! Sounds great and I would love a surgery buddy!! I'm finding myself going a little food crazy...I believe this time of year doesn't help either!!! Your lucky, my deductible is 3000! How is your diet before? Mines only a week and not just fasting

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Gendy    27

Gendy
Posted

I have to start my liquid diet on 12/24/14. I have to be all liquids for 2 weeks before, I think it's mostly Protein Shakes. I will find out Tuesday when I see the dietician what my exact diet will be.

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LSF    264

LSF
Posted

My pre-op diet is not just liquids - it's a low carb - mostly Protein & veggies. Just waiting for approval.

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LSF    264

LSF
Posted

Well. I received a letter from Cigna today- they want more info from the surgeon as to why the revision is medically necessary!!! I just spent 3 months going through ALL their requirements!! So upset!

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LSF    264

LSF
Posted

I was approved!!

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LSF    264

LSF
Posted

Peecheeie & Gendy,

I'm following up to see how you are both doing since your revision surgery. I just had mine 2/4th. Still on the liquid phase

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Go To Topic Listing Gastric Sleeve Surgery Forums

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