Getting Denied !!!

emtcmw
on 11/11/09 9:21 am - NEWPORT, TN
Hey all got paperwork sent friday and got a call today from doctors office saying that I had been denied due to my bmi was not over 40. The requirements on cigna.com advises your bmi can be less than 40 with 2 co morbidities or more. I have that, they say my insurance is different.. Has anyone had this problem and I dont understand how they can tell you one thing but not list it as a requirement.. If u have any feedback please let me know 
Thanks !!! 

Carla

    
melsreturn
on 11/11/09 10:56 am - Madison, TN
Go online and get a copy of the criteria, or contact the insurance company and ask them for it in writing...  or  you can go to your human resource department.  Go over it, make sure you have everything documented, and then take it back to the insurance company (perhaps some papers were missing), call someone at your employer in the benefits department and tell them you need help in getting something covered that you should be treated for... etc.  Do not give up easily.  Keep on fighting until you know you've exhausted everything and that their NO is really NO.  Insurance companies say NO the majority of the time just so you will say "well, ok" and forget about it.  That means they don't have to pay that money out, they gain interest from the money they would have otherwise paid on your surgery.  Keep fighting if you are within your benefit limits.



 

Bob L.
on 11/11/09 12:27 pm - Clarksville, TN

Mel's right you need to be on top of it stay polite but persistent.  Putting yourself in control will give you great comfort.  Hang in there!  C'ya Bob

emtcmw
on 11/11/09 7:25 pm - NEWPORT, TN
Thanks Bob for all the encouragement, it means so very much! All of you here are a wonderful support system!

Carla

    
emtcmw
on 11/11/09 7:20 pm - NEWPORT, TN
Oh I am not going to give up easy ! I It may be a long hard battle but I am ready !!! Thanks for the encouragement!

Carla

    
Fancee
on 11/11/09 2:24 pm - Nashville, TN
i have Cigna too and had a hard time with them, but finally got approved.  You might want to check with your employer to see what stipulations, if any, they have put on bariatric surgery.  Even though i have Cigna, I work for the State and they have some very different requirements than Cigna themselves have. 


      
emtcmw
on 11/11/09 7:16 pm - NEWPORT, TN
Ok well that makes more sense! Thanks for the info I will check wih them today to see what the differences are !!

Carla

    
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