Question:
I called member services for Cigna HMO of Arizona to find out what I
need to qualify for WLS surgery. They told me that I have to talk to my Dr. office. (tried talking to a supervisor) I then called my Doctor's office and they said that Cigna is supose to tell us. The insurance lady for Dr. Blackstone said that Cigna won't tell patients the requirements for surgery so that they can deny the patients claim later. Is this legal? I thought they had to give me answers about what my policy covers instead of giving me the runaround. Has any one else had to deal with Cigna recently, have they done this to you and how should I deal with them? Thanks so much. Brandy — Brandyraj (posted on April 8, 2003)
April 7, 2003
Brandy...call them up and ask them for a copy of your benefits manual
(though you should have gotten a copy when you got the insurance and every
year afterwards). The doctors/surgeons office have too many insurance
companies to deal with to keep straight the requirements of each one. If
CIGNA has its coverage policy bulletins online (like Aetna does), then you
might be able to look at them online...JR
— John Rushton
April 7, 2003
Cigna is so hard to deal with. Cigna's website has a facility where you
can get an id and see your benefits on-line. When I went through this with
them last year, I had to have multiple co-morbidities, be 100 lbs or more
overweight, have 3 12-week supervised diets in the last 5 years, one of
which must be in the last year (I had to do it before approval) and letters
of medical necessity. I had high blood pressure, osteoarthritis, asthma
and chronic bronchitis. Took from January 2002 until May 2002 to get
through the 12 week diet program and get approval, after one appeal. I
had surgery in August 2003 and am down about 130+ lbs. since then. (I
don't weigh too often.) I did lose about 41 lbs between January and
August, so it wasn't a total loss, but the stress of waiting was awful.
Just keep climbing those ladders at Cigna and you'll work your way through
the muck.
— Cathy S.
April 7, 2003
Brandy- Cigna WILL NOT tell you what the requirments are over the phone.
And the website wont be much better. I was denied twice for not having all
my ducks in a row but they WILL pay as long as you dont give up and take no
for an answer. When they turn you down, they will give all the reasons why.
Use it as a guide as to what to do next. Hang in there and do what I did
while waiting, I kept telling myself that there is a small spot in He** for
insurance folks. Doesnt help but it sure made me feel better. Keep strong
and have faith. Sidney Open RNY 10-23-02 down 80+
— Siddy I.
April 13, 2003
Hi! A lot of my profile has to do with this subject.My experience with
cigna has been awful.
— jennifer A.
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