Cigna Denied my TT

Fiat2m4
on 12/1/13 7:00 am

Hi guys, I've been going through the forum for a couple of years now but I finally took the plunge and decided to post. I had my RNY in Sept of 2012 and so far I've lost 140 lbs. Life is great, I mean the change for the better in my life is unbelievable, if you would have told me I probably wouldn't have believed you. I go to the gym 5-6 times a week, I've joined crossfit, and this is coming from someone that couldn't stand for more than 3 hours w/o my legs falling asleep. Well to make a long story short my RNY surgeon Dr. Alverdy from the University of Chicago Recommended me to Dr. Zachary, I met w/ Dr. Zachary and I was immediately impressed, he was a true pro and very direct and honest w/ his approach. After many appointments w/ different surgeons I knew Dr. Zachary was the one, I could just feel it. I knew he was the surgeon for me. Dr. Zachary submitted the letter to Cigna the very next day, he told me to give Cigna and his nurse about a month to hear back and i did, very patiently. However When I called Cigna to no surprise they could never find any notes in my file. However one of their reps told me that they had received the letter and that they had sent Dr. Zachary a request for more information. I called 2 weeks later to find out that this had been a lie. So I finally wised up and demanded to speak w/ a supervisor. After all that they told me that they were going to submit the claim to Pre Authorization and to give them about 5 days. After that time passed I called back and they told me that they were going to need the photos to submit to the Medical director. Then the doctors office sent the photos and guess what? They sent them to the wrong department of course, who knows were my photos are now? So then I requested my doctors office to Scan them and send them via Email, which I think is something that should have been done in the first place. Anyways after all that waiting and all the hell I went through turns out the Medical director denied my claim. So needless to say I'm very discouraged but i'm trying to keep a positive outlook. :-) I'm going to try to appeal the decision but I'm going to need my Primary doctor to back me up and I don't know how that's going to go. Also The procedures my doctor had requested were skin excision, panniculectomy, lipo, and breast reduction, I'm a male, lol. If anyone else has any success stories w/ Insurance companies or has any advice I'd really appreciate it. At this point i'm going w/ my backup plan of going to Colombia and having it done there, can anyone recommend a surgeon there for WL patients?

hollykim
on 12/3/13 9:30 am - Nashville, TN
Revision on 03/18/15

can't help with the insurance issues,but h e you considered using Dr. sauceda in MX? Many from this forum use him and there was a group started on OH ,of ppl who ha e used I or are going to use I'm. 

I will be spending two weeks with him early Jan 2014. 

GL

 


          

 

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