CIGNA, CIGNA, CIGNA!!!!!

Is that anything like "MARSHA, MARSHA, MARSHA"? I am fed up to my ears with Cigna and not really sure what to do from this point. I am hoping maybe there is someone out there is OH land that may be able to help or offer advice.  I'll start from the beginning. I was banded on the 11/27/2006. I was approved by Cigna after 7 months of fighting. I work for a family physician, so I was able to arrange a peer to peer with my Primary care and a Cigna appeal doctor. She was on the phone for a total of two minutes before the appeal doctor granted my approval. No big deal. That was all it took.  Here's the problem....... My mom who is 53yrs old, 240lbs @ 5'3 with SEVERAL co-morbities, that has completed atleast three physician controlled, documented weight loss programs was denied. The first time stating she did not have "six consecutive months" of weight loss attempts. So... she had five on her most recent attempt... she has completed 8 months of that very same weight loss program to date. So she waited a month and submitted an appeal with the updated six month weight loss attempt. They denied that too. So, with try #3 they finally told her she was "APPROVED" Yipppee?? Right? They told her the letter would be there in 15 days. Well, the letter showed up and it stated.. "she was approved on an out-patient basis"  well... thats all fine and dandy but there was no "auth" #'s in the letter like there was in mine. Here's were the problem comes in... The bariatric center will NOT do surgery with out authorization #'s so that they get paid. Cinga will not GIVE the auth #'s because it wasnt approved, it was "pre determined" and with pre-determination it only means they will pay for it after the surgery is done. The bariatric center wont do it with out some form of a quarentee of payment. Even though auth #'s are not a quarentee of payment, they wont even schedule surgery without them or the money upfront.  They told my mom that she could pay for the surgery in full, and they would reinburse her. She cant do that first of all, and there is no quarentee they will give her the money back when its all said and done.  So right now, thats were we stand. I called and talked to a girl in the pre dermination department for 30 minutes today and got no where. My mom called this afternoon and demanded to speak to someone of "upper management". The purpose of this being that Cinga said they were going to send another approval letter, that was sent November 28th, after my moms peer to peer review. She promised my mom she would fax the approval letter to both her family care and the surgeon. The lady I spoke to today said they could NOT do that. So... ? Who knows whats going on at this point.  My questions are.... Has anyone out there been down this road?  What did you do to fight it? What should we do from here? Is there any hope at getting this approved at this point?  Im not sure where to go from here. My mom is completely upset over this whole ordeal, its been almost a year and she's been let down several times by Cinga as far as this is concerned.

Hi Paul :) Thanks for your reply.  Im still on my mothers insurance plan until I graduate from college. So yes, same plan, same employer.

You should keep trying.  CIGNA is known for this nonsense.  You should appeal, and also file a complaint with Florida's AHCA.  They're very good when it comes to any company playing games.  We slammed CIGNA a few years ago, for Dr. Jawad in fact, because they purposely held off on any decision until my client's insurance renewed and an exlcusion was put into effect.  They made the carrier cover the surgery.

Thanks for your reply. I believe we were told she was only allowed two appeals, and we've used them both. I just got a letter faxed to me for a "voluntary predetermination" in which it clearly states that this not a guarantee that the service/procedure will be covered. Its only purpose is to state that its "medically necessary". I guess at this point she knows more than I do, she's been on the phone this morning with Cigna.