Am I the only one with insurance issues?

I am with Cigna and have been denied with the right to appeal.  My surgeon's office acts totally clueless. They keep giving me different answers and telling me they have submitted things that a week later, I find out that hasn't been sent in.  They have told me that the insurance told them that I am out of network.  This is not true as I called before I started the process over a year ago and I called right away to confirm.  Then they tell me that my procedure is not covered by Cigna, this is not true as I confirmed before and after.  Then I talk to one woman in the office and come to find out she NEVER read the denial letter, just that it had been denied.  I know these issues are one with my surgeon's office.  But, at this point, I need help making sure that my appeal letter gets approved.  Also, does anyone know if Cigna allows more than one appeal should they deny whatever mess my surgeon submits?

Hi  I can assure you you aren't the only one with insurance issues!  I am going through a similar situation but I have Aetna insurance.  But when I read your post, it reminded me of my situation exactly when you say "I know these issues are with my surgeion's office"  I had to do a 3 month dr/diet/exercisse program for Aetna.  I was working towards that but my surgeon's office sent in my paperwork too soon.  So, I received a denial letter!  Ididn't even know my stuff was submitted!  So I called my surgeon's office and they said 'Yeah, I was going to surprise you and get you approved b/c we thought you had 8 months worth of dieting'  True, but it wasn't a supervised diet with a physician!!!!  So I was very frustrated......!   I just fiinished the 3 months, and because I was denied, had to send in an appeal.  I sent 28 pages worth of stuff to my surgeon's office and when i called them they said 'we will fax it to aetna this week'   well, a week went by and finally last week I called aetna and they said they hadn't rec'd anything!  So, I faxed it all over to them myself.  Then i called the surgeion's office and they had not yet sent it!!  Frustrationg!!!!!

Anyways, my point is, I found out the hard way....you have to take care of things yourself!  Find out what your insurance requires.  I talked to the lady in Appeals at Aetna and she is super nice.  Said that my company allows only ONE appeal.  So you need to find out from CIGNA who many appeals your company or your policy allow.  Each can be different.  You also have a certain number of days to appeal.  For me, it was 60 days...and that was from the time i received the denial letter.   So I am glad I called myself and am dealing with the insurance myself.  I called back my surgeon's office and told them to not send anything to Aetna or call them on my behalf, that I was handling my appeal.....they said that was fine.

I would take the matter into your own hands and submit everything yourself!  I'm glad I did!!  I hope to be hearing this week sometime if I'm approved!

Good Luck to you!

Nan

 

 

 

Thank you for your response.  I was wanting to get involved but was afraid that I would get in the way of the "process" and end up messing things up.  Thanks.. I'm calling Cigna, Monday morning.

I know, me too.  I was so afraid of getting involved thinking I would mess things up and get denied b/c I sent it myself rather than the surgeion's office, etc, but for me, that was not the case at all.  I was so glad I called my insurence and took care of everything myself.  Otherwise, I think I'd still be sitting here waiting for an approval.  Good luck to you and let me know how it turns out!
Nan