Question:
I have Cigna open Access plus it has been over six weeks since my claim
has been submitted I have been cleared by the Psychologist and the Nutritionist everything was done the way that Cigna has wanted it... I can't understand the hold up! I am going through the Cleveland Clinic I have called them both... and they both say that I haven't been denied and that things are going ok.. any input to my delema would be appreciated thanks so much! Jeannie — Jeannie M. (posted on June 27, 2007)
June 27, 2007
I would talk to the weight loss director and ask why is it taking so long.
Also the surgeon and the Insurance companyt. I understand that the process
can take several months to complete. I think patients is a virtue, however
I know where you are coming from, and it is easy for me to say. I haven't
as yet gone through the entire process. Not a whole lot you can do but
relax and not freak out. Good luck to you. Some Ins. Co's are just slow.
— bderuiter
June 27, 2007
Hi Jeannie, waiting can be such a hard thing! I remember it well. When I
was waiting for approval, after the paperwork was sent, I called my
insurance company, they acknowledged that they had the documents and that
they were in order. I called them every 3 days after that until they
answered. I was VERY nice to them, and just said "oh, I know you have
the paperwork, I was just wondering how the process is going? Do you need
anything else?, blah, blah, blah". I just politely kept in touch with
them, and in 3 short weeks I had approval. I called my surgeon to tell
them! Just call your insurance company about every 3 days, don't show any
frustration or anger, that works against you, but just remind them that you
are really looking forward to moving forward, and that your plans for
surgery would need approval soon (while the kids are home from school they
can help you, etc.). They will respond soon. Take care. Patricia P.
— Patricia P
June 28, 2007
I thought they legally only had one month to approve or deny, you could ask
for their procedure outline in writing or check out NIH online, I think
that is where I read that. We've got our fingers crossed that your
"yes" comes soon!
— dawnie125
June 29, 2007
All companies have medical policies which they must disclose to you. Many
are available online. Being "nice" to them has nothing to do
with it. You will either meet medical necessity criteria or you won't.
That being said, there are plans that have weight loss surgery included
only if your group has purchased a rider to include it. Self insured
groups can vary widely if they cover weight loss surgery or not.
Some commercial plans exclude WLS altogether. It then becomes a benefit
issue not one of medical necessity.
— AllisonWonderland
August 5, 2007
Jeannie
I fought with Cigna for nine months to get them to approve my GB. What
finally helped was speaking directly to the case manager. She helped push
the process through.
Valerie
— valwess
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