Cigna... Denial question

[shoptek 8]

Hello all,

I'm still trying to get a straight answer from Cigna, and my doctor's office has been wonderful in assisting me....

Last week I got a letter requesting more medical info for my VSG procedure. The doctor promptly replied.

Today I get a denial letter. Actually, it reads "The employee must have 2 years of continuous service with the company for coverage to be available"

I've been with my company 25 years, Cigna only since 01/2015.…...I'm trying to find out what "2 years of service" they mean.... With my company or with Cigna.

Very ambiguous.

If they mean with Cigna, what are the odds they'd "bend the rules" 4 months early? I was scheduled for mid August surgery.

Thanks!

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[sc101071 398]

I would guess you qualify. If employer is paying for the coverage it would sound like you qualify. See if a letter from HR would resolve the matter.

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[KristenLe 5,980]

You are not an employee of Cigna - so I assume they mean your employer. I would call Cigna and explain you have worked for same company for 25 years. Don't let them get away with this BS.

[wellah 14]

I'm currently fighting a smaller denial with CIGNA. They are trying to charge me $78 for the initial welcome group meeting for the Bariatric Program, saying that it was not a direct one-on-one appointment with a doctor. I've asked the clinic for a recode, and discovered that I can have CIGNA send it for a recode / review if the clinic doesn't change the coding. If neither of those work, I've prepared a 20 page packet for my appeal of the denial. Includes the paperwork from the clinic, my doctor's referral to the program etc.

Good luck in getting yours cleared up! I WAS able to confirm that the surgery itself IS covered under my policy, so hopefully when I'm finished with all my appointments (by October 8th) they will approve the procedure for me.

[shoptek 8]

The plot thickens.... my wife looked at my employers coverage paperwork, and Cigna is the administrator. My employer, a very large company, self insures.

According to all of the documents, i should qualify without a doubt.

Just more hoops to jump through lol

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[Ale Nunez 80]

My insurance took three weeks to approve. Best of luck!

[walkermy 86]

I had issues with Cigna as well, I believe they do all they can not to pay. Stay on them.

[Dee~Dee 107]

I had issues with Cigna as well, I believe they do all they can not to pay. Stay on them.

Wondered if you would mind sharing your experience with Cigna? Of course, they are my insurers as well... Any insight helps.

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[Dknal2 1,066]

I was just approved by Cigna and I was shocked. I know they usually deny everyone but they approved me in 5 days. I have sleep apnea and SVT(increased heart rate)that I take mess forso I knew they were going to say I didn't have 2 co morbidities plus my BMI was 38... I was scared to even try but it worked thank God.

[Vinasu 621]

I also had Cigna, but I was approved in less than a week...they only required a three month diet ahead of time.

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