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Cigna denial x 2 and Peer Review



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I started this journey last spring. I did everything by the book but did not loose weight through the process. Part of it was I had to have a major surgery a couple months back before I was eligible for the sleeve. So going into the insurance submittal, I thought for sure that was what would hang me up. I got my first denial 3 days in. They said my surgeon wasn’t in network. However they sent me to his office and his partners in the same office were . That brought appeal 1. I was then denied again after 2 weeks. This time they said I didn’t qualify because I didn’t do all of the steps. Turns out some person at Cigna forgot to look at the whole packet of paperwork that held my nutrition visits, the extra steps, psych evaluation, etc etc etc. but because this was the 2nd denial, opening my case back up required a peer review appeal.

I am happy to say as of this morning I am approved for surgery on Monday (18th)!! I have spent today going to appointment after appointment to last minute get things in. I am sitting in the room now for my ore admission counseling and all I can think is please God let there be no other hurdles! I am ready for this! I’ve prayed in this!

Let’s do this!

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This is great! Congrats! I just got a 'denial' for my $130k bill submitted to insurance even though I got an approval letter. I called them and they said its a byproduct of my insurance being out of state - they requested medical records to show that my surgery and procedures were necessary but they had to request them from my states BCBS. So we'll see how that goes.

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congratulations!

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And May all things smooth out- believe you're playing this game in the correct manner and your goals are in sight FINALLY!

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