Question:
Has anyone ever been approved for the surgery and told that it was covered 100% ...

then your surgeon calls a week later to say that his all of his fee won't be covered. Apparently Cigna only covers $4800 of the surgeons' fee but he charges $6500, leaving the balance to be paid by the patient. I was told that my papers from Cigna will say patient portion $0.00. Does Cigna think they are paying 100%, but the doctor is charging more to the patient?    — D. N. (posted on November 5, 2002)

November 5, 2002
If your surgeon is participating then he has an agreement with Cigna that he will accept a certain amount from Cigna as the fee for his procedure. As a participating surgeon his fee is reduced to the agreed fee. The patient isn't then charged for the difference. Now if he is not participating then there is no agreement to reduce his fee and you would be responsible for what they did not cover. That's my understanding anyway.
   — judylj60

November 5, 2002
I had my surgery Feb, 2001 - I'm with PacifiCare HMO - they paid all fees, except for psyc. evaluation which was $100.
   — connie m

November 5, 2002
Judy is correct. If your surgeon is contracted with Cigna, you do not have to pay the difference. Your doc is in the wrong to ask for it even. If he is not a participating doc, then you may have to pay. Talk to your customer service rep at the insurance comapny,and ask them if this is OK for him to charge.
   — Vicki L.

November 5, 2002
I had my wls on February 27th 2002 and my insurance company is Freeport Regional Health Plan through Goodyear Tire Company,they paid everything except for the 10.00 co-payment for doctor's office visits. they are also paying for my tt/breast reduction/lift that I am having on December 2nd..
   — bikerchic

November 5, 2002
I had my surgery in November 2001 and my surgeon was paid in full. However, the full payment from the insurance company wasn't the amount he charges - it was teh amount that he and the insurance company had negotiated for payment as per his contract with the insurance company. The same held true with the hospital.
   — Patty_Butler

November 5, 2002
My doctor is a participating doctor and I want to ask Cigna about it, but at the same time I don't want to ruffle any feathers. I don't want to piss the surgeon off who's going to have me on his table in three weeks. I feel like I'm between a rock and a hard place.
   — D. N.

November 5, 2002
I am a little worried about that myself. My hospitial bill was 30k and cigna only paid a little over 12k. They said that was what was contracted and my responsible is 0. I dont really trust them so I will have to wait and see if I get a new bill. Good luck to you....
   — Debbie W.

November 5, 2002
The first thing you'll want to do is check your member handbook and see if your surgeon is listed as a network provider. If he is, he is a contracted provider for Cigna and per contract, must accept Cigna's allowable for the surgery fee. If your policy pays at 100% with no deductible, then you should owe nothing. If you don't find his name in your handbook, he's probably a non-participating provider and in that case, he can charge you whatever he wants. Your very best bet would be to call Cigna (just call the 800 number on the back of your insurance card) and discuss this with them. They can look your doctor up in their system and tell you if he's "par" or "non-par". Tell Cigna what the doctor's office told you - that you would have to pay the extra amount and see what they have to say. I know these things can be mighty confusing - I'm an insurance biller by vocation and I had a hard time too! Best of luck to you!
   — Traci A.

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