Hi everyone,

First off, I would like to apologize for the length of this post, but I'm at the end of my rope here and SO upset!! Second, if anyone has ever been through something like this please feel free to add your input.

Like a lot of you I've never been so motivated and excited in my life for my upcoming surgery. My husband's employer has CIGNA insurance. They have never covered bariatric surgery until what I thought was this year. In prior years they had our plan documents on their website so you were able to see the specifics of what was covered and what was excluded. We had many changes this year but for some reason they have never put this detailed information up on either the employee website or the CIGNA website this year. Needless to say, I contacted CIGNA for this information on more than one occasion. FINALLY, I received information in the mail with very detailed information saying that weight loss surgery WAS covered. Imagine my happiness!! I even contacted CIGNA via phone to verify this and it was confirmed as covered. I started all of my paperwork and submitted it to my doctor's office. The doctor's office ALSO contacted CIGNA and they were given an approval of coverage for the surgery and a reference code for the call. The requirements were for 3 months of doctor supervised weight management along with the usual psychological evaluation, high BMI, sleep apnea (check), diabetes (check), high blood pressure (check), etc. Therefore, my journey began and I stuck to the program like crazy.

I went in this past Monday for my final doctor's visit and they submitted my paperwork to CIGNA. My claim was immediately denied by CIGNA saying that weight loss surgery is not a covered benefit. If you could only see the look of despair on my face. The doctor's office informed CIGNA that my surgery is scheduled for June 23rd and that I have done absolutely everything required. CIGNA told the doctor's office that they have given the case to their supervisor and that my doctor's office would have to submit an appeal (IN WRITING, which will only slow down matters). My husband also contacted the HR benefits manager who was livid that this had happened. She informed him that they have never covered bariatric surgery and that there is NO appealing this situation.

I am having a very hard time believing that nothing can be done, especially on the part of CIGNA's more than one error. They informed my doctor's office that the employee who told them that I was approved would be reprimanded - do they honestly think that is going to make me feel any better? What about the others who sent me the information in the mail and by phone? I contacted CIGNA on Tuesday and said that they apparently have problems with training their employees. This is not something that can be brushed off as a slight error! CIGNA needs to pay for their mistakes!

One other thing of mention is that CIGNA has paid ALL of my claims regarding this preparation for the surgery, including my BARIATRIC Vitamins at 100%!! I just don't get it.

I don't know what to do with myself at this point. I am just absolutely heartbroken and numb. I've worked so hard for this and to have the rug pulled out from underneath me at the last minute is just wrong.

Thanks for reading and your understanding!

losinit512

Cloud nine is an understatement, haha!! I was out to lunch with my son and was starting to feel defeated but I couldn't make myself order anything unhealthy. I'm so glad I stuck to my guns because right when they brought our food out, the phone rang with THE call. I'm so excited!

I am hoping what happened to you isn't happening to me.

My docs office submitted almost 2 weeks ago and today Cigna said they didn't have all the info they needed and was going to deny (via letter) when everything they said was missing WAS submitted. The doc office is resubmitting today what was missing and hoping for approval. Just BS that they say stuff is missing when it's their in front of them to hold up the process. Very frustrated. Wanted to hear accepted this week since I did all I was suppose to and all was submitted. UGGGH! No guarantees I understand even if you meet all the qualifications. Just have to pray and be patient something I am not very good at. And why are they approving and paying 80% of all the prep appointments for surgery if not going to approve surgery. Crazy

Sue

Cloud nine is an understatement, haha!! I was out to lunch with my son and was starting to feel defeated but I couldn't make myself order anything unhealthy. I'm so glad I stuck to my guns because right when they brought our food out, the phone rang with THE call. I'm so excited!

I'm so happy for you!! I'm glad you decided to fight.

Hi Sue,

I hope you're not going through the same thing I did either. That's something I couldn't understand either - why they approved everything up until the last minute. Patience is not my friend either and it was one LONG nerve-wracking week of fighting. I guess the only advice I can give is to keep pushing up the ladder. If you can't get a response from who you are talking to ask for a supervisor. I hated having to do that but I just couldn't settle with them telling me no. I have a close friend who is going through this as well. Her surgery is scheduled for July 14th and she is also having to be persistent and fight. I'm beginning to think the denial process is becoming standard practice among the insurance companies.

Good luck to you and keep me posted on how it goes!

Nancy

And why are they approving and paying 80% of all the prep appointments for surgery if not going to approve surgery. Crazy

Sue

Because those things are not surgery, they are office visits, radiology, etc. Pretty much everything I had done before I was approved could be done for someone not having surgery.

I had:

Surgical consultation

nutritional counseling

psych evaluation

upper and lower endoscopy

colonoscopy

pap smear

lab work

I have Cigna. I knew the "revision" surgery I wanted was covered but when the paperwork was submitted it was denied. I called and found out that the denial was only because they wanted it done at a different hospital so we re- submitted the paperwork. It was approved immediately and my surgery was 5 months ago. Good luck

Here is a link to the most recent info about the procedure coverage from Cigna. Hope this helps ????????

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

I got denied through cigar as well on first attempt. Said they didn't have all the proper paperwork. Dr office resubmitted the same day they got the denial and it was approved the following day. Funny thing js she submitted everything the same as she previously did. I think it's just laziness on cignas part. Glad u got your approval