Do Insurance companies hate us?- LONG

kamelion63
on 3/22/10 10:03 am - McKinney, TX
I have Cigna and long story short have applied for approval for a revision from a band to RNY due to complications.

So we submitted 03/05 and I havent heard anything and people on OH said to call.
Well I did call and a really nice lady said she didnt see where anything had been submitted but she said that it didnt mean that it wasnt there. ?!!????***???!!!
So naturally I call my care advocate at my surgeon's office and she said they submitted the original paperwork and have even received a reply that they will need more information bu.t the Dr's office couldnt figure out what they were asking for and since have left messages to get clarification. She said she would call again today and call me back if she heard anything. Needless to say I believe my Dr's office because I have no reason not to. They WANT you to get the surgery.
So I call back to Cigna and a really sweet guy told me that the Dr's offices call a medical review board and submit things. I asked if I could have the number so I could call to make sure that I couldnt help with whatever it is they need.
He told me that it is a provider line only and that they will not speak to me, only the doctor's office!!!!??? He told me that I would need to call the Dr's office to see what they need. Does this make sense that I am CUT out of my own care?
So I will call the Dr's office again tomorrow and see if they got anywhere but what crap they are spewing while being so nice? He even told me "Good Luck Hon"  WHAT?

I never heard back from the Dr's office so I am guessing she never heard anything.

I just cant believe all of this run around.....what in the world can I do?
Did anyone else experience this with their revision?

Kamelion63

Lap Band 10/2007 Had complications  - waiting on approval to have band removed and revised to RNY with NEW surgeon Dr. Nicholson!

HW 315 SW 286 CW285 GW 180

"I'd rather be hated for who I am, than loved for who I am not." -Kurt Cobain
smileyjamie72
on 3/23/10 12:47 am - Palmer, AK

Bottom line, yup.  The insurance companies are not our friend.

The best thing you can do, is be patient,and do what you are doing, keeping in contact & asking questions, try not to go crazy in the mean time.  I have been working on mine for a year, we finally submitted last fall, and did not get a denial, but not an apporval either (it is all in my profile).  So, 5 LOOONNGGG months later I am STILL trying to get one last test done, so we can re-submit. 



Hang in there!!!!
-Jamie

RNY 2/26/2002                           DS 12/29/2011
HW 317                                     SW 263 BMI 45.1
SW 298                                     CW 192 BMI 32.9~60% EWL
LW 151 in 2003  
TT 4/9/2003

Normal BMI 24.8 is my GOAL!!!

 

 

 


 

 

 

GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**

kamelion63
on 3/23/10 12:58 pm - McKinney, TX
Thanks and good luck.

I guess I thought it would go a little smoother because it is a revision and my band was proven to be medically necessary so why not after complications should the RNY then be covered?

Oh well guess I will have to just hurry up and wait.
Kamelion63

Lap Band 10/2007 Had complications  - waiting on approval to have band removed and revised to RNY with NEW surgeon Dr. Nicholson!

HW 315 SW 286 CW285 GW 180

"I'd rather be hated for who I am, than loved for who I am not." -Kurt Cobain
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