Anyone have Insurance (Cigna) approve surgery to just deny it after all clearances were done?

[JOJ 0]

Cigna had originally approved procedure, gave my doctor a list of clearances I will need. Then after all clearances were done they denied it. Has this happened to anyone before? Is there anything we can do about it? It is super frustrating to go thru all these tests and then be denied.

[Matt Z 4,140]

6 hours ago, JOJ said:

Cigna had originally approved procedure, gave my doctor a list of clearances I will need. Then after all clearances were done they denied it. Has this happened to anyone before? Is there anything we can do about it? It is super frustrating to go thru all these tests and then be denied.

Appeal the new decision and be sure to point out that the procedure was already approved. 9 times out of 10 the appeal will be approved. I'm pretty sure it's just a money saving technique employed by the insurance companies to try to limit having to pay for the surgeries. Like pretending to walk away from buying a car to try to get the dealership to lower the price, the insurance company might be trying to see "if you are serious".

[Walter Lindstrom 42]

It won't make you feel any better but I will tell you this happens ALL THE TIME with many payers - not just CIGNA (although we've had more than our share of battles with them). It is infuriating when you jump through all these hoops (most of which are "baloney" or another "B" word!) only to be told "no" at the end. Sometimes the "no" is more of a clerical issue that can be easily dealt with - other times it is much more involved. CIGNA just updated its medical policy and that change very well may have complicated how your preauthorization request was handled. (I've attached a copy of the updated version for you to look at. In many ways it is more "patient-friendly" but I'll bet your case was reviewed under a more restrictive medical policy.) You do have appeal rights available now so I recommend you give us a call so we can find out more about why they said no and give some guidance about your various options. Hope this helps.

CIGNA medical policy effective October 9 2018.pdf