Any insurance experts in the group that could offer advice?

I think I'm getting screwed, and everyone seems to know it but no one can help me, so I'm hoping there is someone in the industry that might be able to offer some advice.  I'll try to make it as short as possible.  After two years of denials, Blue Cross Blue Shield Anthem approved me for abdominoplasty  approximately Dec. 15, 2012.  Well, now I understand why they found every reason to drag their feet and lost my file repeatedly, by doing so, they managed to keep from having to pay for my surgery because my company changed to a new insurance carrier on January 1, 2013.  

Now Cigna, my new insurance carrier says I have to go through the approval process all over again, which their standards are even more strict than BCBS and will probably be at least a 6 month delay. 

My human resource department says they are trying to "work it out" but honestly, I doubt they are going to be able to make Cigna pay for this surgery even though honestly with the deductions and such, it would cost Cigna less than $4,000. 

I would consider hiring an attorney if I knew what type of attorney would handle this type of case.  Does anyone have any idea of things I can do to make this happen?  I am the kind of person that makes things happen, no matter who I have to call or who I have to visit, I just am at a loss as to who I could contact in this situation.  I currently still have my surgery date scheduled for February 6th but if I don't get an answer soon, my plastic surgeon is going to cancel it.

Thanks for any help you can give me!

Robin  

Unfortunately, you are at the mercy of the insurance that you are insured under on that date of service - the surgery date.  Since you have new insurance, you will have to follow their guidelines.

So sorry.....

Any way for you to self-pay for your BCBS policy until the surgery is complete since you've been approved?

Sorry for all the delaying tactics you have been subjected to.  I have fought through an approval process with patients, gotten written approval, and then been asked to return the funds because they made a mistake.  They are now witholding payments on other patients who I have worked with since then.  

Texas has an insurance board that you can make a complaint to, but they have no enforcement authority.  Lawsuits, outside of class action are way to expensive.  Best idea is to get them their documentation exactly as they require, follow the rules, and get a doctor who will work with you.

Here is a link to my page on insurance approval:

http://drlomonaco.com/houston/patient-resources/

Just a follow up message, after almost a month of many phone calls, Cigna has approved my surgery!   My surgeon did cancel my surgery date, but he has dates open for later in February so I'm fine with that.  I'm just happy that I was approved!   By the way, I was told by someone that works in the insurance industry that the "squeaky wheel gets the grease", so that is why I pestered everyone in my HR, my union and with Cigna that I could possible think of - numerous times.  Maybe they got it approved just to get rid of me or it was the right thing to do, I don't know and I don't care! 

I'm going through the same thing.  I posted a question on this before I saw your post.

I got the insurance switched to Anthem, but the agent placed me in the wrong plan.  The surgeon only deals with the Preferred tier.  I have a medically necessary skin removal procedure I'm dealing with.

I finally got it straightened out after 6 months, so I'm having to go through the switching process again, which has put me behind in getting the surgery done. I took a one year leave from my second trip through college to get the surgery done, and now because  I have to go through and pay for another consultation, because it's been so long since the initial consult. All this has eaten up 6 months of my leave.

Personally, I think it's because the surgeon prefers to deal with cash patients, and it's an effort to discourage me from having the surgery.

Hi Jazzy, Sorry it's taken me so long to get back to the forum to respond.  I went to your profile and read a bit about you, sounds like you kind of live in the middle of nowhere or else you would just find a different surgeon.  Well, best get it done as early this spring as you can.  I've heard it's hell to have to wear the compression garments in the hot weather.  I hope you have the money to pay for the 2nd consultation.

As for myself, I think I did post that Cigna finally did the right thing and approved my surgery.  But then they approved it for the incorrect surgery codes, so the surgeon's office is still trying to get things ironed out before I can get a surgery date.  So close but yet so far...sigh.....

Robin

Cowgirl-

Not many experienced plastic surgeons in my area for post-bariatric skin issues, and this is not a very progressive town, despite being the home of the Fighting Irish (Notre Dame). My alma mater (Indiana University) built a medical school right across the street from Notre Dame, where students can be pre-med, but have to go elsewhere for medical school. Indiana University is right there to keep the students (and the money) in South Bend, Indiana.  

The consult was $56.00 the first time, so I'm assuming it will be the same, but with the recession being what it is, I'm sure prices have gone up.

I'm just wondering if it would be better to try to petition my current insurance for an exception, or just switch insurance again.

It is definitely hard to find good plastic surgeons in some areas, so if you have a good one, you're one step ahead.  As far as seeing if your current insurance company will make an exception, well you can see how that goes as long as it doesn't take too long.  Hopefully you'll have better luck than I.   So since you aren't taking care of family anymore, are you planning on staying put in the town you are living in? 

Cigna is continuing to screw me over.  Now they only want to pay for a panniculectomy, where as I had been approved for an abdominoplasty through Blue Cross Blue Shield Anthem.  In addition, Cigna has managed to **** my plastic surgeon off so much that he might not even be willing to accept Cigna anymore.  I'm supposed to go in and talk to him on Tuesday and see what we can work out.  If this doesn't give me an ulcer or a brain aneurism before this is all over, it will be a miracle.  I know Cigna is just doing everything they can just to get out of paying for the surgery, or paying as little as possible but the thing is that we are a self funded union plan, so I have already paid high insurance for years for this.  It is not Cigna's money, they are just managing it! 

Cowgirl-

I'm definitely planning to get the heck out of Dodge as soon as I get this surgery done and healed! 

You would think a town with a major university would be in this century with the rest of the world, but not so!

The town where I went to college has a major university, and is smaller than this, but far more progressive!