Insurance denied - Cigna

[Febmeltdown 2]

Was on the fast track doing everything right and got a call today my 2/12 date has to be rescheduled as insurance denied the claim.

When I called Cigna, they told me I needed 3 months of visits, but they told the hospital 90 days. So now looking into late April.

Bummed to be so close and get halted.

Anyone experience similar?

[Newme17 3,444]

Uh, three months is about 90 days....you should ask them to be more clear and present your visits again...that is, if you’ve got those three months of consecutive visits. I have Cigna as well, but it took just about 4 months from start to finish. When did you start your journey?

[Febmeltdown 2]

Started in August but took a break due to illness.

“Official” first visit was 12/19/17 so that was just 50 days ago according to Cigna. I’m going to reach out to them directly again later. Hoping I can make this work somehow. I had a visit in Dec, Jan and Feb.

[KatFight 207]

Maybe I'm not understanding fully. If your official first visit was 12/19/18 then you need 90 (3 months) consecutive days. The days will not add up to 90 by 2/12/18 unfortunately. Even if you had 3 visits one in Dec, Jan, Feb, you do not have 90 days yet so that's an easy explanation as to why insurance cannot approve your surgery at this time. And that really stinks.

It's understandable that your deeply disappointed bc they gave you date of 2/12 and now you hear otherwise. I have BC/BS and had 3 months visits as well. Because of a problem with one of the doctors' offices, my 3 months turned to 4. Then I was approved and had a date by the 5th month. I think it's probably rare that a surgery is done to the day of the 3-month mark bc you have to have 90 days first and all clearances then paperwork is submitted and there's a wait for approval.

Hang in there. You'll get through this.

[KatFight 207]

Maybe I'm not understanding fully. If your official first visit was 12/19/18 then you need 90 (3 months) consecutive days. The days will not add up to 90 by 2/12/18 unfortunately. Even if you had 3 visits one in Dec, Jan, Feb, you do not have 90 days yet so that's an easy explanation as to why insurance cannot approve your surgery at this time. And that really stinks.

It's understandable that your deeply disappointed bc they gave you date of 2/12 and now you hear otherwise. I have BC/BS and had 3 months visits as well. Because of a problem with one of the doctors' offices, my 3 months turned to 4. Then I was approved and had a date by the 5th month. I think it's probably rare that a surgery is done to the day of the 3-month mark bc you have to have 90 days first and all clearances then paperwork is submitted and there's a wait for approval.

Hang in there. You'll get through this.

[KatFight 207]

Oops. Didn't mean to end twice

[Apple203 1,314]

I think many of us get caught by the 90-days, thinking 3 visits meets the criteria when its really 4 visits, right? It stinks to get delayed. Hang in there!

[Febmeltdown 2]

Started in August but took a break due to illness.

“Official” first visit was 12/19/17 so that was just 50 days ago according to Cigna. I’m going to reach out to them directly again later. Hoping I can make this work somehow. I had a visit in Dec, Jan and Feb.

[Febmeltdown 2]

Thanks for your responses... I just wish they were more clear with me on my initial call and said 90 days vs “3 months of visits”. I’m going from 2/12 to potentially 4/30 as a result. And of course, just bought my “liquids” etc for my two days fast last night.

Obviously not the end but just feeling deflated... thanks for listening/reading!

[Febmeltdown 2]

34 minutes ago, KatFight said:

Maybe I'm not understanding fully. If your official first visit was 12/19/18 then you need 90 (3 months) consecutive days. The days will not add up to 90 by 2/12/18 unfortunately. Even if you had 3 visits one in Dec, Jan, Feb, you do not have 90 days yet so that's an easy explanation as to why insurance cannot approve your surgery at this time. And that really stinks.

It's understandable that your deeply disappointed bc they gave you date of 2/12 and now you hear otherwise. I have BC/BS and had 3 months visits as well. Because of a problem with one of the doctors' offices, my 3 months turned to 4. Then I was approved and had a date by the 5th month. I think it's probably rare that a surgery is done to the day of the 3-month mark bc you have to have 90 days first and all clearances then paperwork is submitted and there's a wait for approval.

Hang in there. You'll get through this.

I understand the timeframe issue but that’s not how it was conveyed to me when I first reached out to Cigna. Thanks for your reply.

[FluffyChix 17,410]

Yeah it sucks. It has to be consecutive--no breaks. And for me, I was told it would be 90 consecutive days, but it actually had to be 120 consecutive days.

I'm still waiting for the hospital to confirm I'm covered with the insurance company. Apparently they are currently only working on Feb. 14ths day of procedures (as of today). It's a nailbiter, and I'm not out of the woods and on the table yet! Mine is set for Feb. 20th, but I'm mentally braced to take whatever comes. You know? LOL.

[Febmeltdown 2]

46 minutes ago, KatFight said:

Maybe I'm not understanding fully. If your official first visit was 12/19/18 then you need 90 (3 months) consecutive days. The days will not add up to 90 by 2/12/18 unfortunately. Even if you had 3 visits one in Dec, Jan, Feb, you do not have 90 days yet so that's an easy explanation as to why insurance cannot approve your surgery at this time. And that really stinks.

It's understandable that your deeply disappointed bc they gave you date of 2/12 and now you hear otherwise. I have BC/BS and had 3 months visits as well. Because of a problem with one of the doctors' offices, my 3 months turned to 4. Then I was approved and had a date by the 5th month. I think it's probably rare that a surgery is done to the day of the 3-month mark bc you have to have 90 days first and all clearances then paperwork is submitted and there's a wait for approval.

Hang in there. You'll get through this.

18 minutes ago, FluffyChix said:

Yeah it sucks. It has to be consecutive--no breaks. And for me, I was told it would be 90 consecutive days, but it actually had to be 120 consecutive days.

I'm still waiting for the hospital to confirm I'm covered with the insurance company. Apparently they are currently only working on Feb. 14ths day of procedures (as of today). It's a nailbiter, and I'm not out of the woods and on the table yet! Mine is set for Feb. 20th, but I'm mentally braced to take whatever comes. You know? LOL.

I feel like I was just accepting this was happening and then boom... lol!! Best of luck... hoping it’s a smooth ride for you!

[Jennifer_RNY 4]

This happened to me, however I had an appointment with my pcp and discussed WLS and that was noted. Insurance excepted that and I came in for another dietary visit. I started September 2018 and had my surgery December 18 2018. I realize that my process was really fast. I am a surgery scheduler and work for the hospital I had my procedure at. You will get there.


Roux 12.18.17
SW 312
CW 245
GW 170

[Febmeltdown 2]

17 hours ago, Jennifer_RNY said:

This happened to me, however I had an appointment with my pcp and discussed WLS and that was noted. Insurance excepted that and I came in for another dietary visit. I started September 2018 and had my surgery December 18 2018. I realize that my process was really fast. I am a surgery scheduler and work for the hospital I had my procedure at. You will get there.


Roux 12.18.17
SW 312
CW 245
GW 170

Wow... good for you!! Your stats are impressive too!

I actually called my coordinator last night and mentioned I had a pcp appt in Nov if that would help my “case” at all and not have to wait another 11 weeks. Doesn’t hurt to try.

Thabks for your feedback!

[Jennifer_RNY 4]

Wow... good for you!! Your stats are impressive too! [emoji4]
I actually called my coordinator last night and mentioned I had a pcp appt in Nov if that would help my “case” at all and not have to wait another 11 weeks. Doesn’t hurt to try.
Thabks for your feedback!

Have you heard back from your surgery case manager? Did you talk about bariatric surgery with your PCP?


Roux 12.18.17
SW 312
CW 245
GW 170