Can CIGNA do this????

Our employer changed insurance carriers to Cigna at the first of 2007, at which time I found out our coverage actually included bariatric surgery.  Ecstatic, I immediately started inquiring about what the requirements were, etc.  One of the first things I checked on was if the hospital that performs surgery where I live is an "in network" provider.  YEAH...all checked out ok.  The hospital was listed on Cigna's website as a preferred provider.  I called member services...they substantiated that the hospital was an "in network" provider.  So the process began.  I have spent the last 6 months completing the 6 month diet, nut evals, psych eval, sleep study, etc. etc. etc.        Now that the 6 month diet is over, and everything has been submitted to insurance for approval CIGNA is claiming that the hospital is out of network, therefore I can't have my surgery there!!!!  The hospital is still listed on their website.  Just yesterday I called Cigna and spoke to 4 different people within member services.  Each one told me that the hospital was "in network".  When I ask why they are denying me due to being "out of network"....they come back and tell me that this hospital is only contracted with Cigna for behavioral services, and not medical.  Why was I never told this?  Can Cigna do this?  Nobody ever mentioned that the hospital was "in network" for only mental health services, and to me this seems fraudulant.  I'm into this now for over 6 months, and already several thousand dollars, all for them to come back and deny the surgery..  Please advise!!!!

My heart goes out to you, Jeannee.  I don't know the answer to this question, but you must be so upset with Cigna.  I worked for BCBS of FL for several years and never heard of anything like this.  I encourage you to fight fight fight.  Are there any other participating facilities in your area?

Nope...not within 100 miles.  I checked with my surgeons office today...to see if I have to have my lapband done elsewhere if he would do the follow up care.  They are telling me no.  Now I'm wondering about my surgeon cause that seems pretty sh*tty to me.  I don't want to have to travel over 100 miles every time for my post op care. 

I can understand why your surgeon is telling you NO that they wont do the follow ups and fills, because if there are problems with the operation, he will have to deal with them and that isnt a fun or easy job for them.  They also dont feel comfortable working behind another surgeon. As far as having to go 100 miles to get to another doctor to do it... please fight with your insurance company about this... We had to do this with one of my husbands doctors (Neurological Surgeon) since none were on the plan and within 50 miles of us.  After a short battle they paid IN NETWORK to this doctors office. Keep  up the fight

Sally made a good point.  Many insurance companies have policies when there are no participating providers within a certain distance. The policies will typically pay the provider at the participating rate.  The bad part is that the hospital (provider) doesn't have to accept the insurance allowed amount, so you may be billed for the difference.  This is usually a very large amount on hospital claims.