Seeking someone with similar experience...

I'm trying to figure out where I am in the insurance approval process. My surgeon's office was verbally told the WLS was covered with requirements to follow. Then I received a letter from a 3rd party source requesting documentation for "pre certification" including physician supervised weight loss program, medical neccessity letter from family dr., registered nutritionist counseling. Fortunately I had completed all - now I just keep waiting and wondering what I'm waiting for... Has anyone experienced similar? I keep reading about approvals and being denied, but that appears to be from the insurance company, not a 3rd party review system. I've also read on-line that this certification does not actually constitute a coverage of benefits. Anyone w/ similar I'd love to hear your story. Mine has been dragging on since Oct 07 when I first completed the Dr. 6 mos. weight loss visits! Kim

Hi Kim   , Just wondering, who sent your request to be reviewed by this 3rd party? Your Insurance carrier or your employer? Cathie

The request was sent from Pathway Management. My insurance is Sloan's Lake and I work for a mid size company that owns about 23 television stations and has about 1,500 - 2,500 employees. It's a little unsettling. My surgeon's office submitted my claim for the surgery December 15th. This has been the longest month ever. First my insurance sent out a generic letter stating that it "appeared" at this time the procedure of Lap Band was not covered by my policy. Then I got the letter from Pathway a week later. Then everything has been in review for the past month. My policy states it will cover WLS that is medically neccessary and I guess Pathway was contracted to determine medical neccessity.  The entire process since I made this decision has taken about 11 mos. so far - including the waiting period while I did the physician supervised 6 mos. Now getting to the back end of it all it's overwhelming to keep waiting week after week! I'm sure most on here can sympathize.  It just seems like everyone on here references a quicker process w/ their insurance to get to the initial approval or denial. I sure hope after all this that I do not get a denial - that will be torture! Kim

CIGNA"s about to get their head handed to them for letting a small girl deny while they denied a kidney transplant.    Keep on them, and cal both agencies to check status.