Question:
For 5 months Cigna has said yes, now 3 wks before surgery they say NO..

I need everyones help and suggestions. I am supposed to have my surgery on 4/13 and as far as I knew and Bariatric Treatment Ctr knew, I had been approved since 10/24/00. Although now CIGNA says an approval letter is not a guaranty to pay that Dr. or hospital, but an approval letter just means that they will pay an approved Dr. or hospital. On 3/22 BTC called Cigna to see if there were any expenses that I had to cover and CIGNA said yes all of it. They are claiming that because I am going out of network they will not cover this. They have known since July of 2000 that BTC was out of network and they continually assured me it was covered. If at anytime prior to 12/31/00 they had told me it was not covered I could have switched my insurance plans at work to have it covered. Up to this point CIGNA had been great, now they are just trying to shift the blame to me. They said I was not clear with them when During the numerous times I have spoken with them since July of 2000. They even went over their notes with me and I do not know how much clearer any of this could have been. At no time during the last 8 months has CIGNA said that this would not be approved until yesterday. What can I do? Who can I contact? Any help would be greatly appreciated....    — Barry R. (posted on March 24, 2001)

March 24, 2001
I sure am sorry you are going through this- it sounds like the insurance company is whacked! BTC wouldn't have let it have gone this far if you weren't covered- and they don't accept self pays, so I don't think BTC would have wasted your time and theirs unless they thought you were covered. Can Cigna tell you what surgeons ARE in your network? What does BTC say about this? I guess I would call Cigna and keep asking to talk to supervisors until you get a better explanation. I would also investigate the surgeons Cigna says they will cover. If they cannot name anyone in your network in your area, I think you have a great chance to appeal their decision. Good Luck and don't give up!
   — M B.

March 24, 2001
DO YOU HAVE A COPY OF THE APPROVAL LETTER WITH THE CORRECT PROVIDER.... IT SOUNDS LIKE BTC DROPPED THE BALL... ARE THEY CONTRACTED WITH CIGNA. CIGNA IS WITHIN THERE SCOPE OF PRACTICE TO STATE THAT YOU MUST ACCESS IN NETWORK PROVIDERS. HAVE YOU REVIEWED YOUR BENEFIT GUIDELINES? IF YOU DO NOT THEM CONTACT MEMBER SERVICES AT CIGNA FOR A COPY... CIGNA MUST PROVIDE YOU WITH THESE GUIDELINES AND A LIST OF PROVIDERS... GOOD LUCK
   — [Anonymous]