been denied, trying to stay positive but. . .

I received a denied letter over the weekend. I have just called my Doc and Insurance. Back in March my doc's office called the insurance company (Cigna) and they had told them that it is normally excluded but covered if "medically necessary" I have called today and they are retracting their statement and saying that they never said that and it is NOT COVERED by my employer...Now I'm so frustrated and upset. 

How has gone through this crap and came out with surgery in the end? I'm sure I need to call my husband's HR (have the insurance through him) to find out if they will be willing to add it...I really doubt they will, but I will try and I feel so defeated...

If I had found this out back in March I never would have gone through all this trouble and get my hopes up...

So can you give me some advice on what to do or say next

Thanks so much,

You can always file a second request (and the proper name is escaping me at the moment), and see what happens. I think lots of people get a denial the first go round.

However, if they specifically said that your employer did not opt into the coverage, then that means that it's probably not covered.

That stinks, and I'm so sorry!

I'd definitely do some digging though through your husband's employer and have the doctor's office to it on their end as well!

Yeah,

I'm just bummed and pissed because back in March the insurance company said YES I was covered...if they had told me NO I wouldn't have wasted my time and money on WLS...would have started other options...it's just so depressing...I"m still going to call HR and see what I can do or what they can do for me...I'm trying to still have hope ... but it is slowly failing

Just as a note going forward - always always be the one to contact your insurance directly about coverage questions because docs offices sometimes don't get the right info or they mix up different people and give wrong info. Sometimes they never even do an actual verification of benefits. And always get things in writing.

I am so sorry you are dealing with this. All I can say is hang in there as best you can. Always remember that the only thing we have control over is ourselves and what we do TODAY. Even if you are denied, that doesn't mean your journey is over. It just means you might have to take a different path. You never know if/when insurance changes, job changes, ability to self pay arises, etc. You don't want to go gain a ton of weight because of this and just make your journey that much more difficult. Please feel free to reach out if you need to talk or need support!

I was a self-pay. Although I did not go this route, I know that my doctor's office offers financing through an outside company. You might want to check on that. 

I totally needed to hear that. My journey isn't over, just maybe a different path. I call HR tomorrow and see what things I can do. 

Thanks again,

I'd call the insurance people directly and ask for a copy of your insurance that shows wls is excluded & find out when your policy renews. If you can swing it maybe you can get insurance on your own, not thru your husbands employer, they might cover wls that way, especially since you've already gone thru some ins hoops. 

I believe there is away around it...I suggest making sure its coded correctly with your insurance...

I believe there is away around it...I suggest making sure its coded correctly with your insurance...

I am hoping to have surgery soon...however, the insurance has been denying payments...when I called I was informed it was auto coded and/or processed.

So, they are now pulling all the denied claims and reprocessing them...pending precert filings(I failed to personally oversee initiate)