cigna ppo....are the worst!

I just wonder if a lot of you have went thru what I just went thru? Last July called cigna..asked if there is an exclusion to gastric bypass.....on no they said, just need letter of medical necessity. Okay no problem BMI is 60, diabetic, HBP, etc. Got that to them within 2 months....then...oh yeah..you need 6 month weight loss medically supervised and pys eval. okay, took 6 months got all that done. Turn that in and the end of this July....That day they came back and said...oh, your company dropped that part of the plan 4 months ago....talked to company...mad as h***! Said they didnt know and I was one of 6 in this shape, they will talk to cigna and SEE what they could do....Okay...so I wait for a response...and wait....cigna told the company that we never did have coverage to cover gastric bypass. Talked to Cigna rep today who said...oh, all you have to do is get a medical necessity letter and turn that in....I told him I did, twice now! HE says he can find no record of it in their system. And that it would show if I had been denied and that I have never even been submitted for it! BOY, was I hot! But, he hasnt a clue, because I have everything well documented along with the doctors office. Then cigna comes back (thru my employer) and says I was denied every time! WHAT THE H+++!!!!!!! That is when I was told by the woman who takes care of this at the doctors office that CIGNA is one of the worst about FLAT out lying....stalling.....loosing paperwork....you name it! Needless to say...I am going to Mexico to have lap banding.......I will never take a job with a company that uses CIGNA insurance again.....and I plan to send a letter straight to the top of my company and CIGNA as to all this b+++sh++!!!!!!!!!!!! Wow, I feel better now! Thanks for the Vent! Ellen

I'm sorry Ellen they put you through this but some of these insurance companies really stink. BCBS of IL is another one that plays games with you so your not alone. Makes my hair stand on in when I think of the sh%$ they pull on people and get away with it I always wonder what they would think if it was their loved one wanting and needing WLS. Donna

Ellen, Don't convert your money into pesos just yet... First of all, there are a lot of good lessons for you, as well as anyone *****ad your story: 1. Never believe ANYTHING any one tells you over the phone. 2. If it's not in writing, it never happened. 3. Read your SUMMARY PLAN DESCRIPTION BOOKLET before submitting a claim to know whether a service is covered or not. 4. Don't take NO for answer. 5. Document every conservation - get name, rank and serial number. 6. NEVER fax anything. FEDEX or UPS so you have a signed receipt and you can track it. Now, get a copy of your SUMMARY PLAN DESCRIPTION BOOKLET that was in effect at the time of your request for prior authorization. Look under exclusions. Is there an exclusion for treatment of Morbid Obesity? If not, you need to appeal. Cigna gives you 365 days from the date of your denial letter to appeal their decision. In all probability, your employer is self insured. This means that they pay the claim out of their pocket, and a fee to Cigna for being the Claims Administrator. Don't listen when they say they'll talk to Cigna, unless they are calling Cigna with instructions to approve your request. Here's the only catch I see. Cigna is not paying Lap Band right now, claiming it's experimental. (What BS!!!) If WLS was not an exclusion in your Plan at the time you requested surgery, and you decide to have the RNY instead of the band, you should prevail. Of course, you will need to resubmit EVERYTHING to Cigna. Fight the good fight! Roberta

Hi Ellen Thank you for sharing your story. I am very sorry that you have had to go through so much drama with CIGNA. I am also covered by CIGNA and am in the process of sending my medical records to Barix Treatment Center this Thursday by registered mail so that they can look them over and then submit them to CIGNA. I was denied once because I had not met all the requirements, but Barix had accidentally sent in my paperwork too soon....but anyway, all the sorted details are in my profile. I hope that I don't have the same experience with CIGNA that you did- I am not sure how I will handle it if I do. But at any rate, I wish you success with whatever decision you make to have WLS. You will be in my prayers. Take care ~Sharonda