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CIGNA DENIED ME AGAIN!

Ashoryb

By Ashoryb, in Gastric Sleeve Surgery Forums

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Ashoryb    52

Ashoryb
Posted

I've done and cleared every single thing they asked for and they denied me again I have a bmi of 53 sleep apnea and other things and have completed everythung and they denied me! Omg I'm so pissed right now. I have no idea what to do literally shaking.

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tailor-made    33

tailor-made
Posted

I'm so sorry to hear that. Call and ask questions. Then contact your surgeon's office. I didn't get an answer until I started getting on people's nerves. It took longer than expected but I finally got that approval and believe you will too!

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Ashoryb    52

Ashoryb
Posted

Did they say why they have denied you?

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They said they would send me a letter with the reasons why in a few days

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Ashoryb    52

Ashoryb
Posted

I'm so sorry to hear that. Call and ask questions. Then contact your surgeon's office. I didn't get an answer until I started getting on people's nerves. It took longer than expected but I finally got that approval and believe you will too!

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I called my surgeons office and they said they would take it to the next level. I also Called my hr department as well and told then I need their help. I've just gotta calm down. I'm just so hurt

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I know I sound like a drama queen but I've done everything.

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tailor-made    33

tailor-made
Posted (edited)

No you don't sound like a drama queen. I know how hard it was for me to just wait on a response from them for approval and can't even begin to tell you how I would have taken it if they came back with a denial. You've done everything you're supposed to do and your feelings are justified. It makes no sense they wouldn't tell you why though. Try going over the reps head to speak with a manager.

If you don't mind me asking, what did they saythey denied you for the last time?

Edited by tailor-made

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CBT    450

CBT
Posted

You also can inform CIGNA that you are filing a complaint with the insurance commissioner.

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certifiedcoder    11

certifiedcoder
Posted

I have heard that most cases from my surgeons office have been approved after appeal. It is terrible that they make you "wait for the denial letter" to learn why they are saying no! I agree, get on the phone. As long as you meet the criteria, I would ask for a one on one between your surgeon and Cigna's Medical Director. Don't back down if you know it should be covered.

Good luck!

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Ashoryb    52

Ashoryb
Posted

No you don't sound like a drama queen. I know how hard it was for me to just wait on a response from them for approval and can't even begin to tell you how I would have taken it if they came back with a denial. You've done everything you're supposed to do and your feelings are justified. It makes no sense they wouldn't tell you why though. Try going over the reps head to speak with a manager.

If you don't mind me asking, what did they saythey denied you for the last time?

The first time I was denied it was because the wanted me to get pulmonary clearance and blood work. I did all that re submitted. But again denial. Thanks so much for understanding l. I almost broke down into tears at work

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Ashoryb    52

Ashoryb
Posted

You also can inform CIGNA that you are filing a complaint with the insurance commissioner.

That's a great idea I will Def do that!! Dee my insurance is with cigna but through a third party for businesses called group administrators. So they are the ones being so crazy

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I have heard that most cases from my surgeons office have been approved after appeal. It is terrible that they make you "wait for the denial letter" to learn why they are saying no! I agree, get on the phone. As long as you meet the criteria, I would ask for a one on one between your surgeon and Cigna's Medical Director. Don't back down if you know it should be covered.

Good luck!

I def won't back down. This is literally life for me so I'm gonna do whatever I can until the bitter end

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newlife4me67    4

newlife4me67
Posted

My insurance wouldn't cover me at all. So I took came up with $ 4,300 and had the surgery in Mexico on 3/11/16. I needed a drastic change in my life and wasn't going to wait around insurance to cover me. Recovery hasn't been too bad, lots of liquids and Protein shakes so far. Looking forward to solid food but I know to wait until my stomach is ready to handle it. I started at 200, lost 7 on the pre op diet, just weighed myself and I am 182 :D :D :D . Oh my gosh it is working, cant wait to I get to my goal weight. If you can afford it, go to Mexico for surgery. I was treated very well.

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liposuction68    178

liposuction68
Posted

I would call them back keep your foot on their neck. that is what i am doing now. i was denied the first time they said it was missing information so everything was done and my doc resubmitted last wednesday im still waiting if i get a denial again i am prepared with plan a plan b and plan c....they can tell you over the phone you ask the rep to talk to a manager immediately they cannot deny you that that is your insurance that YOU pay for..

good luck hun.

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Jessica Ellison-Correa    66

Jessica Ellison-Correa
Posted

Just because Cigna covers wls not all plans do you need to get the wording of your policy in writing and go on that

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josiek1988    70

josiek1988
Posted

Just some info. that might help. Most insurance companies have people who just review cases for approval. What they don't want you to know is that most of these people have either no medical background or if they are doctors they are not bariatric specialists. Now tell me what sense is it to have a dermatologist reviewing cases for wls?? So call your insurance company and ask them who reviewed your case and what their credentials and qualifications are. They will tell you some type of specialist doctor. If it is not a bariatric specialist request one. But most of the time they don't want to tell you because it's not a doctor at all. It is just some random person like you and me. Be forceful and do not take no for an answer! You want your case reviewed by a wls doctor! I would be very surprised if you didn't get approved... good luck! I hope this helps!!!

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Go To Topic Listing Gastric Sleeve Surgery Forums

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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

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        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

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