Hey guys,

I'm new to the board but have been following threads for some time now. I started this process in October 2015 and completed the 3 months required diet, psych evaluation etc. to meet Cigna's requirements. I even pay extra through my insurance to include this coverage. I received my letter today that it is not 'medically necessary'. I've been crying all night and so upset. Did I just do all of this and spend all this money on co pays for nothing? Has anyone else encountered this with Cigna and if so, why was it deemed not necessary and what did you do?

well what are their requirements for the surgery being considered medically necessary? Talk to your surgeon, too, because they may be able to file an appeal stating it is medically necessary and that may change the outcome. I'm sorry this happened, I can only imagine how upset you must be. Just make sure you exhaust all possibilities before you give up. Hope things get better for you soon!

Thanks so much for the response.

I meet all required elements for it to be 'medically necessary'. I think that's why I'm so angry, emotional and just really down. It upsets me that we pay for this coverage but are told we can't use it after jumping through all of these hoops.

I've been reading through the forum and it brought me some comfort. I've seen other denials along these lines too that have ended up being approved. I'm trying to stay hopeful but just anxious about having to wait even longer now...

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

I think there is a company who specializes in writing appeals. Anyone remember its name?

Your doctor can also put in for an appeal, I believe. Some insurance companies do this for the first round and then approve upon appeal. Give that a try through your dr. I know how frustrating that is!!

Update today...

Went in to my Drs appt and they said they received the denial letter however received a fax saying its approved. She said she's never seen this before and is going to call just to make sure it's 100%

I was approved!!!!!

Hooray!

I'm sooooo relieved! They called me this morning to confirm they received an approval after the denial. I guess there was just missing paperwork! I was sooooo upset!