Question:
What should I do?

I just recieved an E.O.B.letter that denied my office visit to my surgeon. Does this mean I have a battle with Cigna on my hands? Will the Dr's office resubmit? what should I do at this point? Thanks Guys....    — chinadoll_491 (posted on February 8, 2002)

February 8, 2002
Not enough info to answer this question. Do you have coverage for wls in your benefit package? If not then they probably won't pay this bill. If so then it may be a simple matter of not being filed correctly by surgeon's office. You need to contact customer service and find out #1-do you have wls benefits and #2 what is the specific reason claim was denied. Also re-read the eob. They usually specify the reason the claim was denied.
   — jsuggs

February 8, 2002
Let me tell you my experience. I am preop with a date on 2-27-02, as my original date of 1-28-02 was cancelled because I got the flu. Now my surgery is covered under my plan if deemed medically necesary. But no other treatment that is coded as obesity related is covered. So all my preop testing, surgeon visits, psych eval were not covered. I was getting bills that were starting to add up into the thousands. Since my journey started in august, I was starting to get threatening letters. And here is the funny thing. They were going to be covered the whole time. They don't cover obesity related treatment except surgery that was medically necessary, plus anything that surgery might require pre-op. But all the testing and visits could not be coded as surgery related until it was less than 30 days to surgery. So it all got coded as seperate obesity related treatments until I was under 30 days. Then they paid everything, because it fit their necessary for surgery criteria. Wacky I know, and I am not saying this is your situation, but I figured this may be a common thing for insurance companies, with all their crazy codes and E.O.B's. Check it out, and I wish you luck.
   — kyle S.

February 8, 2002
I also have Cigna, and when I called today to make sure they would cover a LapRNY and was VERY happy to hear that they cover all but a $100 copay for the hospital stay, and 100% on the actual surgery. I'm estatic, especially after reading some of the insurance horror stories on here. I asked how long it would to get approved, and they said that once they received the info from the Dr., it would be 5-7 business days. I have Cigna EPO plan. So far so good. All I need is a referal from my PCP. Maybe it's who you talk to, or which plan you have? Sorry!!! Good luck.
   — Erin C.