Whining for a moment

Ok, today has been one of "THOSE" days and I just wanna either hide with a bottle of tequila or hide and cry or maybe hide with a bottle of tequila and cry. I waited until I'd left work at noon to call CIGNA and check on my paperwork. I was on my way to see the neuro-opthalmologist and on my cell. I finally got a live person and very nicely asked if she could check with Health Services as I had been told Friday that my determination might be done by today. The snitty little chit told me first that she couldn't find anything in the computer about any pre-cert papers being processed. I began getting a little hot under the collar as I explained that there was indeed paperwork in progress and would she please just ring Health Services. She then said yeah ok, I see the papers but only your doctor can clal about this. At this point, I blew a fuse. I demanded to speak to a supervisor at this time. This got a huff and puff from her and asking if it was okay to place me on hold while she called Health Services. I was on hold 20 minutes (on my cell no less) while she spoke to the other department, to then come back and say the benefit analyst who had my case Friday had finished it and it was now with the Medical Director and I just need to be patient. Now by this time, I was pacing and cursing under my breath and figured why the heck not get all wound up so I called BC/BS. What a mistake this was. The customer service rep there told me they had sent out a denial letter end of last week cause BC/BS doesn't pay for WLS unless it's a medical necessity. I asked her how do they define medical necessity if 44 pages of progress notes showing morbid obesity with multiple co-morbidities doesn't prove this. My sarcasm peaked as I asked her if my obituary would maybe get them to think I needed surgery. She then asked me to hold and she would call Medical Review and ask then what was missing. 15 minutes later (yeah, yeah, I know, Sprint is gonna love me) she comes back and says I didn't get denied for the surgery not being proven medical necessary; I got denied because the specific code the surgeon's office used is not a covered benefit by them. She said the surgeon's office used a CPT code of 43847 and didn't have a clue what the code they needed to bill was. I hung up and called my surgeon's office and his secretary, Lisa, said she had not gotten the letter but if I get it before the office, I can fax it to her and she will recode and resubmit. Now if it was that easy, WHY IN THE FRICK DIDN'T THEY USE THE CORRECT CODE TO BEGIN WITH??????????????? Ok, now that I have vented, I feel better or maybe just tired. Anyway, I am no closer to getting a date that I was yesterday.

Kelly, Wow, I am sorry that all that happened. I hope that it gets corrected and approved soon. I pray to GOD that I do not have to go thru that. I am waiting to hear from my insurance company now and I have been calling everyday. Some people are really nice and some are not. I hope one of the nice ones gets my paperwork in their hands to approve it. Hope all gets better for you and I will pray that it does. Tara

Hey Kelly......I am so sorry you had such a terrible day.I have Cigna also and just dread to even start the battle with them.I am in no means a patient person....but I must be because I haven't even started any of my pre-op stuff yet.I just had 7 days off work and didn't even call my PCP to get things started.....If I could get my leg that high,I'd kick my own ASS.I would just like to take a look at these people that approve and deny our cases...they probably weigh all of 100-120lbs.I hope you start getting some good news soon.Keep us updated. April

ok... I get what your upset about. I also was denied and it said it was investigational for that code and Lisa at dr. wrights office resubmitted it with another code and now I am approved.. it took about 2 weeks. now I have to wait a couple of weeks just to get a stupid date set up. arrggg.. I know its upsetting, but you will probably be approved.

I guess, I'm gonna be the odd ball here! I think you just need to be a little more patient... I know you want/need this surgery but it all doesn't come to you over night! By calling them, everyday - I highly doubt is helping you to get approved faster. It's probably just aggravating them to have to answer a million questions when there TRYING to finish up the paperwork and make all the paperwork correct. Be PATIENT! It'll be here before you know it! And trust me, I do understand the waiting can be hard, I waited for a year in half till I found a doctor I liked, then a month for approval! So I've been there and was told the same thing.... BE PATIENT! I'm glad I listened too, and didn't let karma bit me in the ass. Just my 2 cents. -Katie

*sigh* I know that it's very likely the folks at CIGNA have my picture posted in their "***** of the month" spot and they are very likely using it gleefully for dart practice. But see it's like this: I work for this fricking company. And no, I don't think that should get me any favors, but I can guarantee you if I was doing a crappy a job as they are, I'd be written up and out the door. They have whined to me that I don't understand what goes into reviewing documentation; BUT, I work for CIGNA as a Review Nurse on their Medicare contract. I spend 40 plus hours every week knee high in medical records and approving or denying claims for durable medical equipment such as wheelchairs, oxygen, etc. One of my job functions is to take escalated supervisory type calls when a beneficiary is upset. If our customer service reps told a provider or a patient "tough luck, you arent allowed to talk to the nurse", they would be written up. Someday I will have the chance to tell the President of Corporate CIGNA that if they would send their customer service reps and nurses over to the Medicare side for just one month then they could truly learn how to do a job effectively without being labeled "one of the worst insurance companies around". And as much as I want to get on with this, the only thing about the whole process which really gets to me in people doing a shoddy job. I had to fax my own papers in to my insurance company because Vanderbilt couldn't get it right. I had to wait months and months to get an appointment to see the doctor, but thanks to my crappy HMO insurance, which I pay out the nose for every payday, I had to go to who my PCP sent me to. And from the looks of Sheila's post, even when I get approved, then I will still have to wait weeks and weeks for someone to decide when I can have surgery. If any of you have ever researched the socialization of medicine in other countries, then you will see a likeness here. Bottom line is, I am the consumer. I feel both the insurance company whom I pay and the doctor who I see should treat me like someone important and not just a number. Chances are I won't change how things are, but I will make my voice heard. Ok, I am done ranting now. My call to CIGNA today got yet another please call back because the Medical Director will be done with your case and it should have a determination by COB tomorrow. Btw I was nice today and didn't lose my cool. Sheila, do you know what code they changed your paperwork to that got it approved? BC/BS promised to fax me the denial letter so I can fax it to Lisa for recoding. I hope this finds you all very well and much love to each of you. Kelly

Kelly, I understand where your coming from, really! I went to Dr. Wright also. He was actually the first doctor I saw about GBS. I had nothing put problems with the office... He may be a good doctor - but if so, I don't see why he lets his staff treat his patients so awful. It truely makes me wonder.... -Kate

Hi sugs, sorry you had a bad day. I'm like most, I wanted it done yesterday. I can't sit still and wait. The stress would cause me to smoke more. But reading about the hassles of insurance coverage scares me to death. I have medicare/blue care of TN, and both are suppossed to cover the surgery, but by the time I get a dr, their rules could change that fast. I can just say, to hang in there, but don't let them forget you either. I wouldn't call them everyday, every other day, but not everyday. Best of luck to you sugs, Kathy

Insurance can be a ***** I expect they always will be and nothing we can do is going to change that. Just be persistant, and keep fighting, they are hoping you will cry and go away and cease requesting help. if you do they win. if I can be of help check my profile and contact me. I am wishing you the best of luck.