Cigna

I received this letter today:

"Dear *surgeon*

We received a request from  you on 11/1/2010 for *name* for coverage of the following services(s):

Laparoscopic Sleeve Gastrectomy (43775).

After review of the information submitted, we are unable to substantiate medical necessity for the requested service(s).  To process your request, we need the following additional information:

Fax any pertinent clinical information supporting the medical necessity of the services requested to *phone number*.  *etc*  "

I know they say it isn't a denial letter, but I feel very sad.  I feel like it isn't going to happen now and all this work has been for nothing.

Jane,

If you can accept the fact that there is a lot of red tape involved, this part of the process will go better.  It's tedious, time-consuming and frustrating.  Just don't give up.  A lot of us had to jump through flaming hoops and pull flowers out of our butt to "prove" we qualified for surgery.

Dealing with this stuff is all part of it.

Colleen

It is not a denial. It is a cue that your surgeon / doc needs to provide more info to substantiate your procedure.  As Colleen said, we all have these flaming hoops to jump throuh. Keep your spirits and head held high and don't give up hope!!!!!
Keeping you in my heart and prayers!

Hi Cigna...do not give up or let them distract you... it took me 4 years and a chnage of employers to get mine... pray about it and then let God work for you : )...  its funny my health plan covered the surgery but I had decided i was not going to get medical through my employer so i didnt reply by the end of the enrollment period, like a month later my employer called saying I had to go in the system to decline it... well when I wentinI read the plan coverage and saw it said baritic surgery covered... I called and verified it and needless to say took the insurance : )..  good luck and keep trying til they say yes!

Just another of the "flaming hoops".  They seem like the hoops are suspended at pole jumper height.  You can get through this and any other hoops that are presented.  I like the phrase "flaming hoops", they make us see red, use your personal control to douse them with puffy clouds of compassion.  Do come here to vent, this is one of our purposes. 

Hoops, hoops, go away.  Surgery come any ol day.  Hugs