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Topic: RE: denial from cigna?
OMG. I finally got my approval a week ago....It took me 3 weeks to get the approval--and then I find out it as the WRONG approval. Cigna said my hospital was "out-of-network." I've been waiting since November 9. I've been going thru all of this since the end of April! I've done EVERYTHING Cigna wanted me to do. The sleep studies, the pulminary tests, the bloodwork, ultrasounds, the 6 months diet and excercise, the psych evaluation....This is insane! I just don't understand how I could hold up my end of the bargain...and them **** on my heart!
Ummm according to their website AND when I got my pre-approval, everything was all set!
Today I spoke with my insurance coordinator (I was in Vegas when I got the letter saying that it was out-of-network this weekend) and she said she'd handle it.
She called me after having it fixed, but it makes me a little nervous since it's not in writing. I was supposed to pay what was left of my admin fee, my optifast, and get my date today, but I want to know FOR SURE what to expect.
We'll see....
good luck to you!
Ummm according to their website AND when I got my pre-approval, everything was all set!
Today I spoke with my insurance coordinator (I was in Vegas when I got the letter saying that it was out-of-network this weekend) and she said she'd handle it.
She called me after having it fixed, but it makes me a little nervous since it's not in writing. I was supposed to pay what was left of my admin fee, my optifast, and get my date today, but I want to know FOR SURE what to expect.
We'll see....
good luck to you!
Famous last words:
They say that the journey of 1000 miles begin with a single step, but the truth really is that the journey of like a million miles begin with a foot on the scale...--me.
View my website!
www.justxnikki.webs.com
They say that the journey of 1000 miles begin with a single step, but the truth really is that the journey of like a million miles begin with a foot on the scale...--me.
View my website!
www.justxnikki.webs.com Topic: RE: denial from cigna?
Hey girl, I feel for you because I am in the same situation. I waited over a week just to get denied by Cigna. Keep your head up though and keep the faith that this isnt the final answer. I will keep you in my prayers as we make our way through this temporary situation and end up on the loser's bench.
Topic: RE: sleeve vsg has anyone had it approved?
Wow...
I have never heard of an ins co paying for WLS when they were not paid the premiums.
Crossing fingers for you!
On December 13, 2010 at 1:51 PM Pacific Time, LOVELAUGHLIVE wrote:
To Bubblebutt, Yes my ins excludes it.I know they not cover it,thats why I'm appealing it, because they did give me an alternative to a new program that will be offered through their ins, and I would be the first to know about. You never really know what will will happen, but the union rep I talked to thats handling thinks it may go through.You never know I've heard of exclusions getting turned over(not many),but its would worth the wait. Thanks for your comment.Wow...
I have never heard of an ins co paying for WLS when they were not paid the premiums.
Crossing fingers for you!
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
(deactivated member)
on 12/13/10 5:51 am - LOUISVILLE, KY
on 12/13/10 5:51 am - LOUISVILLE, KY
Topic: RE: sleeve vsg has anyone had it approved?
To Bubblebutt, Yes my ins excludes it.I know they not cover it,thats why I'm appealing it, because they did give me an alternative to a new program that will be offered through their ins, and I would be the first to know about. You never really know what will will happen, but the union rep I talked to thats handling thinks it may go through.You never know I've heard of exclusions getting turned over(not many),but its would worth the wait. Thanks for your comment.
Topic: RE: Your surgery out-of-pocket costs after insurance
Yeah, I think you're right. I almost got BCBS but I noticed that they have a lot of little things that you have to watch out for.
I worked for a company that got bought out by UHC so I am a little jaded! I'm sending my information to the insurance coordinator at the surgeons office so she can give me some idea of what I will have to come up with.
I worked for a company that got bought out by UHC so I am a little jaded! I'm sending my information to the insurance coordinator at the surgeons office so she can give me some idea of what I will have to come up with.
Topic: RE: sleeve vsg has anyone had it approved?
We are hoping blue cross will approve the sleeve as it is the right surgery for him... but haven't got a lot to go on...
They were fantastic with my RNY so hopeful... but his pain issues are a deal breaker...
If anyone with bcbs insurance has had some luck with the sleeve being approved we would love to hear from you... thanks
BCBS bases their decisions on the sleeve because they consider it investigational. I wouldn't appeal based on NSAIDs, BCBS covers the band and you can take NSAIDs with a crappy band.
I would appeal based on the FACT that a sleeve is not investigational in the least. It's actually older than the band. Provide studies showing it is not investigational, the ASMBS endorses the sleeve, and it is anything but investigational.
On November 19, 2010 at 10:15 AM Pacific Time, suzle wrote:
I have bcbs massachusetts... Husband needs to be able to take advil because he has had his knees replaced... We are hoping blue cross will approve the sleeve as it is the right surgery for him... but haven't got a lot to go on...
They were fantastic with my RNY so hopeful... but his pain issues are a deal breaker...
If anyone with bcbs insurance has had some luck with the sleeve being approved we would love to hear from you... thanks
BCBS bases their decisions on the sleeve because they consider it investigational. I wouldn't appeal based on NSAIDs, BCBS covers the band and you can take NSAIDs with a crappy band.
I would appeal based on the FACT that a sleeve is not investigational in the least. It's actually older than the band. Provide studies showing it is not investigational, the ASMBS endorses the sleeve, and it is anything but investigational.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: sleeve vsg has anyone had it approved?
Are you saying that your ins co excludes WLS completely? If WLS is excluded from your policy it means that your employer does not pay the additional premium for WLS. If your employer does not pay the additional premium for WLS, you don't have coverage for WLS.
Ins co's want to be paid premiums for services they cover. It's kinda like having car ins but also having a flood in your home. Car ins isn't going to pay for your flood. Medical ins isn't going to pay for WLS if you don't have the coverage to begin with.
If the employer buys the WLS rider, you will have coverage.
On December 8, 2010 at 8:18 PM Pacific Time, LOVELAUGHLIVE wrote:
Wisetears, Have you heard of an exclusion being approved? Right now I'm still in the appeal process, and I had Humana w/the exclusion, so i appealed through my husbands job through the union. I talk to the rep thats handling it ,and it has been oveer a year now,she thinks it may go through its just this healthcare reform thats slowing this up. But now she thinks she may have an answer in Jan.2011. So I told her if she doesnt call I will be contacting her.My best friend thinks I will get somehow I will,but sometimes I really dont see it, like I'm wasting my time,but everytime I want to give up something tells me is not the right time yet and something willsoon. My employer has single plans,but she was willing to offer me funds to pay for it, but she didnt have funds either, but she said maybe next year soon and she will keep me posted. So I'm still waiting and we shall see. Thanks for reading.Are you saying that your ins co excludes WLS completely? If WLS is excluded from your policy it means that your employer does not pay the additional premium for WLS. If your employer does not pay the additional premium for WLS, you don't have coverage for WLS.
Ins co's want to be paid premiums for services they cover. It's kinda like having car ins but also having a flood in your home. Car ins isn't going to pay for your flood. Medical ins isn't going to pay for WLS if you don't have the coverage to begin with.
If the employer buys the WLS rider, you will have coverage.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: Your surgery out-of-pocket costs after insurance
I have GEHA (United Healthcare)
I am trying to gauge how much my out of pocket expense is going to be after the insurance covers their share. I know it varies but I want to get an range. I know I have to pay 15% of the hospital fee but I am expecting more bills as UHC seems to suck. (In my experience).
Amazingly, in comparison UHC is one of the better ins co's. They all kinda suck. ;o)
It's hard to tell, nobody can give you accurate numbers because it depends on which UHC policy you have and what the contractual agreement is between your doc and ins co. But do know, you do not have to pay 15% of what the hospital/doc charges, you will only have to pay 15% of the contracted price. Big, huge, mega difference!
On December 12, 2010 at 4:51 PM Pacific Time, Crabadams72 wrote:
Hey all,I have GEHA (United Healthcare)
I am trying to gauge how much my out of pocket expense is going to be after the insurance covers their share. I know it varies but I want to get an range. I know I have to pay 15% of the hospital fee but I am expecting more bills as UHC seems to suck. (In my experience).
Amazingly, in comparison UHC is one of the better ins co's. They all kinda suck. ;o)
It's hard to tell, nobody can give you accurate numbers because it depends on which UHC policy you have and what the contractual agreement is between your doc and ins co. But do know, you do not have to pay 15% of what the hospital/doc charges, you will only have to pay 15% of the contracted price. Big, huge, mega difference!
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: Your surgery out-of-pocket costs after insurance
Hey all,
I have GEHA (United Healthcare)
I am trying to gauge how much my out of pocket expense is going to be after the insurance covers their share. I know it varies but I want to get an range. I know I have to pay 15% of the hospital fee but I am expecting more bills as UHC seems to suck. (In my experience).
I have GEHA (United Healthcare)
I am trying to gauge how much my out of pocket expense is going to be after the insurance covers their share. I know it varies but I want to get an range. I know I have to pay 15% of the hospital fee but I am expecting more bills as UHC seems to suck. (In my experience).
Topic: RE: Changes to FEP BCBS for 2011
Just an update. I changed back to my old plan. BCBS is also requiring you be at 40.bmi for 2yrs and I am just hitting that bmi this year. Bummer.
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My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 605 views
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