CIGNA? denied before submitted..

I'm gathering info for a relative who has CIGNA Ins. and has been denied. She lives in South Carolina and her ins is CIGNA of Pa. Her PCP agrees she needs the surgery..the surgeon accepted her as a patient. Co-morbids are: high blood pressure, sleep apenea, back pain, reflux. Not sure of the BMI. The surgeon's office called CIGNA for approval. CIGNA denied the surgery itself, not her as a patient. My question is: Has anyone else had to deal with CIGNA and had simular problems? How did you solve them? What type of appeals were needed? Are CIGNA's requirements different from other ins carriers? ... I'd like to print the replies , if anyone wants to send a personal email I can print and mail to her. [email protected]

I am pretty certain that if you go to cigna's website, you can find their guidelines for surgery. There was a link from a post on this site a while back, but don't know if you can find that. Good luck!

I have CIGNA POS and I am in Oklahoma. I called Cigna to find out if it was covered and they told me no also. However I was told to ask if it was an exclusion from my employer. They advised that it was not. So from there I asked if it was deemed medically necessary could they cover. They gave me this site to go out to (below). They will cover within their policy, however the first thing is to find out if the employer has a exclusion because if they do they will not cover it from what I have heard. I am just getting started and haven't sent in a request for it yet...hope this helps.. http://www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf Kendall