University Surgical and CIGNA
My battle began in Jan of 08 with Dr. V of Univeristy Surgical Associates. At the time I had BC/BS of Minnasota through my employer. We got turned down by insurance first try because of needing 6 months of medically supervised weight loss.
No biggie, we went through that and were done by Dec of 08. Both my wife and I we're working this process. When we were done I urged Dr V's support staff to get the approvals/scheduling ASAP because at the time there was potential of my employer switching providers as of 4/1.
The support staff was not quick enough and only my wife was scheduled prior to 4/1 (she had a band put in on 3/23 and is doing fine).
I find out our my company is switching to CIGNA as of 4/1and during the open enrollment period I search for Dr V and he is listed as a provider, cool, no need to explore any other options.
After open enrollment closes (and can't be changed), during a post-op visit for my wife, Dr V's support staff informs me that "as of 4/1 University Surgical will no longer be accepting CIGNA because of the 2 sides negotiating terms" **Note that even after 4/1Dr V is still listed as an approved provider on CIGNA's website**
WTF!!!!!!!!!!!!!
I can't even put my frustration into words. I like Dr V, I want to stick with Dr V so we are still trying to work the process with Dr V's office. But I may be in the market for a new surgeon soon.......any suggestions? Any Dr's that read this forum that can help me? If any lawyers read this, do I have any legal recourse?
No biggie, we went through that and were done by Dec of 08. Both my wife and I we're working this process. When we were done I urged Dr V's support staff to get the approvals/scheduling ASAP because at the time there was potential of my employer switching providers as of 4/1.
The support staff was not quick enough and only my wife was scheduled prior to 4/1 (she had a band put in on 3/23 and is doing fine).
I find out our my company is switching to CIGNA as of 4/1and during the open enrollment period I search for Dr V and he is listed as a provider, cool, no need to explore any other options.
After open enrollment closes (and can't be changed), during a post-op visit for my wife, Dr V's support staff informs me that "as of 4/1 University Surgical will no longer be accepting CIGNA because of the 2 sides negotiating terms" **Note that even after 4/1Dr V is still listed as an approved provider on CIGNA's website**
WTF!!!!!!!!!!!!!
I can't even put my frustration into words. I like Dr V, I want to stick with Dr V so we are still trying to work the process with Dr V's office. But I may be in the market for a new surgeon soon.......any suggestions? Any Dr's that read this forum that can help me? If any lawyers read this, do I have any legal recourse?
Boy, do I feel your frustration!
I just saw my surgeon (a part of the same group) last week who confirmed they were no longer part of CIGNA. She said they have made accomodations in their fee structure for former CIGNA patients with no coverage now who come in for fills - I believe she told me $50 cash for a fill.
As far as recourse, my years of being forced to dabble in HR tell me a few things -- a.) you are out of luck, b.) this is unfortunately between CIGNA and the practice, and you, the patient, got stuck in the middle, and c.) just because a doctor is listed on a health insurer's website doesn't guarantee they currently participate. Any fine print you read about participating providers will have legal wording that basically says the list is subject to change without notice. Insurance companies always tell people to confirm with the provider before assuming they particpate regardless of what the published lists say.
That being said, I'd certainly express my dissatisfaction to Dr. V. the next time you see him -- just that you feel things were not handled timely by his office and now you are in a jam. Won't be a thing he can do about it, but it will bring you some satisfaction to just speak your mind. Ask him personally if they will transfer your records to whatever surgeon you continue with at no charge since they didn't move swiftly.
Then, I would call Dr.'s Pohl and Giovanni to see if they participate in CIGNA. Yes, it will push you over to Roger Williams for surgery (I don't believe they are part of Lifespan), but they are both highly regarded and will help you accomplish your goals.
Good luck to you!
I just saw my surgeon (a part of the same group) last week who confirmed they were no longer part of CIGNA. She said they have made accomodations in their fee structure for former CIGNA patients with no coverage now who come in for fills - I believe she told me $50 cash for a fill.
As far as recourse, my years of being forced to dabble in HR tell me a few things -- a.) you are out of luck, b.) this is unfortunately between CIGNA and the practice, and you, the patient, got stuck in the middle, and c.) just because a doctor is listed on a health insurer's website doesn't guarantee they currently participate. Any fine print you read about participating providers will have legal wording that basically says the list is subject to change without notice. Insurance companies always tell people to confirm with the provider before assuming they particpate regardless of what the published lists say.
That being said, I'd certainly express my dissatisfaction to Dr. V. the next time you see him -- just that you feel things were not handled timely by his office and now you are in a jam. Won't be a thing he can do about it, but it will bring you some satisfaction to just speak your mind. Ask him personally if they will transfer your records to whatever surgeon you continue with at no charge since they didn't move swiftly.
Then, I would call Dr.'s Pohl and Giovanni to see if they participate in CIGNA. Yes, it will push you over to Roger Williams for surgery (I don't believe they are part of Lifespan), but they are both highly regarded and will help you accomplish your goals.
Good luck to you!
Debbie 
Includes 47.5 lbs. lost during 7 month pre-op period
Includes 47.5 lbs. lost during 7 month pre-op period
Sorry your going through this 
I'd be fuming.
Dr. Pohl did both my band & rny (as well as a seperate gall bladder surgery for me, and one for my hubby) and I highly recommend him. Not sure if they take Cigna but try calling them. Carol who works with getting insurance approved for his office is great, she made my revision possible.
I'd be fuming.Dr. Pohl did both my band & rny (as well as a seperate gall bladder surgery for me, and one for my hubby) and I highly recommend him. Not sure if they take Cigna but try calling them. Carol who works with getting insurance approved for his office is great, she made my revision possible.
Anyone who says sunshine brings happiness has never danced in the rain.- Author unknown
Well....it turns turns out that Dr V's office does take my specific Cigna coverage. They are only accepting "Cigna-Tufts CareLink". I finally got my Cigna card in the mail yesterday and what do you know....it's Tufts Care-Link plan.
I blame my employer for this whole mess as no where in any literature we recieved on the new plan does it state "Tuft's CareLink"
Thanks all for your support.
I blame my employer for this whole mess as no where in any literature we recieved on the new plan does it state "Tuft's CareLink"
Thanks all for your support.
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