My packet will be submitted to CIGNA next week. I have Open Access Plan, and my surgeon’s practice is a Cigna Center For Excellence.
Has anyone been denied despite meeting every criteria/co-morbidities articulated by the insurer?
Just curious.
Thanks.

55 minutes ago, Mariann812 said:

My packet will be submitted to CIGNA next week. I have Open Access Plan, and my surgeon’s practice is a Cigna Center For Excellence.
Has anyone been denied despite meeting every criteria/co-morbidities articulated by the insurer?
Just curious.
Thanks.

is your insurance thru the marketplace? like obamacare?

11 minutes ago, liveaboard15 said:

is your insurance thru the marketplace? like obamacare?

No. It’s not through the marketplace.

as long as your insurance covers bariatric surgery, I'd be very surprised if you were denied.

7 hours ago, Mariann812 said:

My packet will be submitted to CIGNA next week. I have Open Access Plan, and my surgeon’s practice is a Cigna Center For Excellence.
Has anyone been denied despite meeting every criteria/co-morbidities articulated by the insurer?
Just curious.
Thanks.

Before my company switched to BCBS of Illinois I had Cigna. They are FANTASTIC about approving things as long as it's medically necessary. For example, I have MS. I take 4 medications for it. ONE of them (Tecfidera) is $8,900 per MONTH. As soon as they had the docs on file that I have MS, they covered it no questions asked with just a $10 copay. My other 3 meds total $3300 per month. Same thing. They also covered my 6 x-rays (3 with and 3 without contrast) every 6 months, no questions asked, because they are needed for my MS. So if your surgeon submits everything to them and lets them know it's medically necessary, I can almost guarantee it'll be covered no problem.

9 hours ago, Future Sleeve Diva said:

Before my company switched to BCBS of Illinois I had Cigna. They are FANTASTIC about approving things as long as it's medically necessary. For example, I have MS. I take 4 medications for it. ONE of them (Tecfidera) is $8,900 per MONTH. As soon as they had the docs on file that I have MS, they covered it no questions asked with just a $10 copay. My other 3 meds total $3300 per month. Same thing. They also covered my 6 x-rays (3 with and 3 without contrast) every 6 months, no questions asked, because they are needed for my MS. So if your surgeon submits everything to them and lets them know it's medically necessary, I can almost guarantee it'll be covered no problem.

Thank you. I feel much better having read that. You apparently, like me, have excellent coverage through Cigna. Whenever I speak with them, they invariably say: ‘your husband has an excellent plan.’ They have covered my pre-procedure tests and those were $$$.
thanks again and good luck to you. My cousin has MS, but she has been given every med available with no good result. ?

3 hours ago, Mariann812 said:

Thank you. I feel much better having read that. You apparently, like me, have excellent coverage through Cigna. Whenever I speak with them, they invariably say: ‘your husband has an excellent plan.’ They have covered my pre-procedure tests and those were $$$.
thanks again and good luck to you. My cousin has MS, but she has been given every med available with no good result. ?

Yes. When I had them, they would comment that my company chose an excellent plan. Worth every penny, believe me. Luckily, BCBS of Illinois is just as good, althogh quite a bit more expensive. Still worth it, though. i will say, I miss Cigna. Absolutely loved them.

4 hours ago, Mariann812 said:

My cousin has MS, but she has been given every med available with no good result. ?

I'm sorry to hear this. What kind does she have? I have RRMS (relapsing-remitting MS). It can be a struggle at times, but there are really good medications out there, and new ones coming out all the time. I'm on the strongest oral med there is, but there's also a lot of injections and IV infusions. Has she tried those?

6 minutes ago, Future Sleeve Diva said:

I'm sorry to hear this. What kind does she have? I have RRMS (relapsing-remitting MS). It can be a struggle at times, but there are really good medications out there, and new ones coming out all the time. I'm on the strongest oral med there is, but there's also a lot of injections and IV infusions. Has she tried those?

She tells me that her doctors at Duke have tried everything that there is to try, I don’t know what type she has, but she did mention a year ago that her doctors had exhausted all options.

you keep fighting the good fight. ❤️

Just now, Mariann812 said:

She tells me that her doctors at Duke have tried everything that there is to try, I don’t know what type she has, but she did mention a year ago that her doctors had exhausted all options.

you keep fighting the good fight. ❤️

That's so sad! There's so many options out there, to have gone through them all and gotten no relief hurts my heart. I hope she gets some help really soon. And thank you for your kind words. I'm stable for now, have bn for the last couple years, but I still get the breakthrough tremors and spasms and head fog (and SERIOUS memory issues) but I've learned to live with them. I will gladly take that over the full blown flares any day.

On 04/14/2022 at 16:35, Mariann812 said:

My packet will be submitted to CIGNA next week. I have Open Access Plan, and my surgeon’s practice is a Cigna Center For Excellence.

Has anyone been denied despite meeting every criteria/co-morbidities articulated by the insurer?

Just curious.

Thanks.

I also have Cigna, but Sisco is giving me hell trying to approve.

On 05/19/2022 at 19:11, vmarlau said:

I also have Cigna, but Sisco is giving me hell trying to approve.

I’m sorry they are giving you difficulty..
I was approved about 2 weeks ago and my surgery is 6/8.
I hope you get your approval soon.

What was the reason for the denial? The denial letter should state the reason why like missing criteria, not a covered procedure (not all plans cover bariatric surgery, especially if it’s employer sponsored coverage), alternative treatment needed for x amount of time?

Cigna is a great insurer, i like them almost as much as i love BCBS/Anthem so there should be a concrete reason for the denial.

I totally misread this as you were denied. Oops.

But for those with employer sponsored health insurance:
Read the denial letter. It will give you information on why you were denied and next steps. Common reasons for denial:
1. Missing criteria
2. Not a covered service under the plan (employers can exclude bariatric coverage from their plans or it’s not offered at certain market sizes such as under 100/small group plans)
3. Alternative treatment/step therapy required such as nutritional counseling, medically supervised weight loss
4. Procedure not covered; alternative procedure covered
Example: duodenal switch isn’t covered but the sleeve is
5. Age -either too young or too old

All denial letters will give you next steps to take action and appeal the decision. I suggest work with your provider to file the appeal.

I’ve been in health insurance for nearly a decade and i have seen these denials before.

YES, I was initially denied. I have BCBS of Minnesota. My BMI was 38.1 with two co-morbidities (pre-diabetic and high blood pressure). They DENIED surgery because I take BP medication and therefore my blood pressure is under control and no longer a risk. That is so ridiculous! Fortunately, the bariatric office manager fought for me and argued with them. BCBS approved me the next day. I had surgery on 4/12/22.

On 5/19/2022 at 7:53 PM, suzannethemom said:

YES, I was initially denied. I have BCBS of Minnesota. My BMI was 38.1 with two co-morbidities (pre-diabetic and high blood pressure). They DENIED surgery because I take BP medication and therefore my blood pressure is under control and no longer a risk. That is so ridiculous! Fortunately, the bariatric office manager fought for me and argued with them. BCBS approved me the next day. I had surgery on 4/12/22.

That's so surprising. I was on bp meds and diabetes meds and was controlled on them, but they were still counted as comorbidites. Maybe it's because you only had pre diabetes and not full blown yet, so they didn't count it. And they usually require 2 comorbidites when your bmi is below 40. I'm really glad your office manager fought for you and you were able to get the surgery. How are you doing since you had it?