MAJOR INSURANCE ISSUES
Ok so last month (August) the bariatric center I have been going to submitted my claim to my insurance CIGNA. I waited about 2 weeks I got so anxious I called cigna to check status and was told the claim was denied. I was so distraught I didn't know what to do. I called the bariatric center the next day and was told the reason they denied it was because they didn't get the dietician appointments and they didn't get the letter from another doctor other then my surgeon that states this is medical necessity. This is not only crazy but FALSE I did get all this info and more for them so why they didn't receive it I'm not sure. I as told that this happened to another person who also had cigna from the same center so it put my worries at ease for a while. Soooo they sent over needed documents and I waited another week to find out but they still denied it. I attempted to work on this issue after feeling like I was alone on this for at least a week and got nothing but the run around from cigna. I finally spoke with a supervisor on Friday who told me that they did receive the documents but the document was NOT specified that this is medical necessity by anyone other then my surgeon. When the bariatric center asked me to call my primary care to get a letter they asked me to tell her it was a "letter of support" not "necessity" I thought I saw a physician that my bariactric center sent me to for that letter and he was supposed to write it for that. I'm kinda depressed Its only been about 2 weeks but if feels like 2 years I'm loosing a lot of patients and I really want to stay focused but THIS IS KILLINGME!!!!!!!!!!!!!!!! Has anyone had this issue please tell me im not alone ?
So it sounds like they still need a letter stating WLS is medically necessary?
I think many people have had issues with insurance companies not receiving the documentation they require. Insurance companies usually have very specific requirements and if you don't meet them exactly, then they have to, per the insurance policy you bought, deny the procedure.
Did you get a letter from another doctor that said the surgery was medically necessary? If so, just fax it to the insurance company again. If not, go see your PCP and ask her to write such a letter.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
Yes. One of the requirements for me was what they called a 'letter of clearance' from my PCP. She wrote the letter, and I was denied for the same reason. All I had to do was call their receptionist and tell them what they actually needed was a 'letter of necessity'. She gladly reworked and reworded the original letter, and I was accepted. The only thing it cost me was a couple weeks of time. Stay diligent and positive, you'll get there! :D
on 9/1/13 3:16 am, edited 9/1/13 3:32 am
Call your primary and make an appointment with them as soon as you can.There are so many ups and downs with having the surgery meaning all the things you have to change and it was make our lives a lot differnent.. I am hoping to have mine before October. Just remember you have to fight for yourself and you can do it. It is what makes us stronger.
I know it feels like it is taking forever but really it's not. I had to spend 9 months on a supervised diet plan with my PCP before I could submit all my paperwork. I finally got done with that and go to put my paperwork in only to find out they forgot to tell me I needed Pullmanery clearence. It took me almost a month to get in to see them, then another 2 weeks to hear back from the insurance company with my approval then I had to wait for another month before my surgeon could fit me in to his schedule. Believe me, patients will pay on in the end, like it did for me.
I hope everything works out. I feel ya on the waiting game!! My doctor just faxed my stuff on Tuesday and I know I have 15 business days to wait for a decision but GEEZ!!! I want to know now!!! LMAO
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.
