frustrated....advice needed

Hello all, I was finally approved by the dreaded cigna, but now I'm having problems with the surgeon's office. My surgeon's office wants a fee agreement, but because they are out of network does not provide one. The surgeon has to administer the surgery and then file a claim with the insurance company. I was told by the insurance lady at the surgeon's office that without a fee agreement there is nothing they can do. I don't understand the problem. If Cigna is going to pay, what is the big deal. If anyone has had a similar experience, I would appreciate your suggestions. I don't know what to do and I am so ready to be on the losing side. Thanks

My surgeon had me sign a paper that said that I would pay a certain amount if my insurance didn't pay and of course, Aetna did pay, so it was a moot point. Are you saying the surgeon wants money up front or what? Who's your surgeon?? You've got no profile so it's hard to tell what's going on. Jan

I apologize for no profile. I'm new and need to update. Anyway, my surgeon (hopefully) is Dr. Keith Kim Celebration Health. His insurance coordinator told me before the holidays if they didn't have that agreement then I couldn't have the surgery. Also, I've been trying to call them for 2 days and there automated system is horrible. I don't think they expect money up front. They just want to know that they will be paid for providing a service and how much they will pay, but I can't change Cigna's policy

You don't have to apologize for being new. You'll get to your profile as you move around and learn this vast site! Cigna will pay your surgeon at the out-of-network rate and you will be responsible for the rest I presume? It sounds like your surgeon just wants to be sure he gets paid and that's reasonable. Like I posted, I also had to sign an agreement that if my insurance didn't pay, then I'd have to pay the fee myself. Jan

Thanks, when I finally get a hold of them, I'm going to mention to her about an agreement I can sign and see if this works.

I ran around in circles for 5 months with US Bariatrics, before I left. They do not have their act together. Read my profile- you'll see what I mean. I am going next week to check out Dr.Murr in Tampa. I heard he's great. Kim

it took me 3 tries to get approved by cigna... good luck to you

I am not an insurance expert -- nor do I know anything about Cigna. But, as a general rule of thumb --just be sure you find out how much Cigna will pay and how much the doctor will charge. Otherwise you could end up owing a lot of money. The insurance company will pay according to THEIR fee schedule which is usually a fraction of what the doctor charges. When you use an in-network doctor they have already agreed to accept what the insurance pays (plus any co-payment you may be required to pay) as full payment, this is a negotiated fee. This fee is generally greatly discounted. When you go out of your network you do not have that assurance. In some ways out of network is almost like being a cash patient, you do not have the advantage of the negotiated discounted fee. Be very careful. You could end up owing thousands. The surgeon's office can give you the billing codes and then you can ask your insurance carrier what the allowable charge is for those codes.

When I first started I had the surgery approved by an out of network DR. The Dr's office needed to talk with the insurance company and the insurance company agreed on a fee structure with the Dr and it was all set. It took less than 48 hours for the agreement to be made. Good luck

I have Cigna Hmo Orlando and had surgery with Dr. Overcash in Ocala and all I had to pay was 600.00 deposit and he is considered out of network b/c he is in Ocala not orlando. Once his office got paid by Cigna I got the 600.00 back. His office at no point asked for more than the 600 deposit. Don't give up on the surgery, if Cigna approved you there are Docs in Ocala and I am sure other places who will do the surgery for what Cigna pays. If you want to know the amount Cigna paid the doc and hospital email me privately and I will give you the figures as to how much each charged and what they actually got paid. Ocala isn't that bad of a drive either. I had no family except my hubby here and my 2 boys ages 8 and 10 and we got through it. You can too, its worth it. Good luck and if I can help further please feel free to email. Take care Michelle