Cigna Denied Again ... Not Cigna's Fault

Apr 14, 2013

Well, Cigna denied me the first time on 4/2 stating they were missing letter from PCP and 3 month nutritional history. My surgeon's office resent the missing docs and my paperwork was sent for reconsideration on 4/5. I was then denied again on 4/12 because my PCP included on the medical clearance/necessity letter the issue with me being iron deficient and that I had been referred to a hematologist for iron infusions. He also stated on the letter that he does not recommend I have surgery until my levels are up! So at the top of the letter he states I would greatly benefit from having the surgery and list my comorbidities but he also included this issue about my iron. 

My PCP and I discussed this before he wrote the letter and it was agreed that he would not put that on the letter that must go to the insurance. He agreed to send that info to my surgeon who at the end of the day would NOT perform an operation with my iron being low anyway; regardless if the info came from the PCP. My labs with my surgeon showed the same exact thing and he informed me I must get my iron up before surgery could be performed. 

I have had my iron treatments and as of 4/3 my iron levels are now NORMAL! I have an appt for tomorrow 4/15 with my PCP and hope to get the revised letter at that time. I will then take it over to my surgeon office in hopes they can do a peer to peer or resend over the letter with my lab paperwork from the hematologist. I'm VERY frustrated at this point because I thought we were clear on how to complete this medical clearance letter. I'm also frustrated with my surgeon office because when they saw that additional info on the letter, why the hell would you send it??? Why not call to let me know I needed to have my PCP change the letter???? I never saw the letter; my PCP faxed it over to my surgeon. 

I've had time to reflect and calm down. All things happen for a reason and I must accept that and just pray that it will be resolved soon. Still disappointed nonetheless, but still hopeful!  

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