Question:
More Denial
well my saga Continues, After almost a year working on getting surgery and being denied 3 times from John Alden, my husband changed jobs, and we researched Insurances, so that I would be able to have surgery. He went to work in April and we got Cigna PPO, and they do not have a exclusion clause that we are aware of. My surgeon sent out the pre approval on June 20, and I Called to check on the status of the surgery and was told I was again Denied. I Am truely devastated at this point. After all the research and all the work I have put into this, again I am being denied. I feel like crawling into a ball, and just crying, and yet i know that will do no good. *Sigh*..I called my surgeons office to tell them what I found out, and they told me not to "give up" that we had to wait for the letter and then we will take it from there. All ive been doing is waiting, and I feel like my life has been put on hold for over a year now, and all the ups and downs are about to drive me nuts. I think ive done all the "right" things. Ive contacted local, and state government,and not given up on getting legislation passed, ive gotten all my doctors, right down to my Gyn. to write letters, Heck my husband changed jobs after 10 yrs to assure me a fighting chance. *Ugh* what do I Do next. Im sorry I keep rambling, but I feel like I have no where else to turn....Thanks for listening. Hopeless in Ohio! — Ann A. (posted on July 7, 2000)
July 7, 2000
Hi Ann,
Hang in there. I know you must feel hopeless. I am not trying to be real
religious here ask God help and guidance. I wish you all the luck.
— Sharon T.
July 7, 2000
Hang in there! I switched from an HMO to Cigna PPO in Jan '00 and had my
surgery approved by March 2000. I had no problems whatsoever with Cigna
PPO. You might want to investigate the denial further, it may be your
husbands employer who is telling Cigna PPO to deny the claim, because Cigna
PPO does not have a specific exclusion for WLS. Also, you might check into
a 3rd party advocate to handle the submission and denial process. I used
Neweigh in Houston. They handled all of the paperwork for submission to
Cigna and were available to appeal on my behalf if I had been denied. It
made it alot easier. Stay positive and by no means accept that denial!
Appeal and fight it! It's worth it! Mark Tomey 3-1/2 mos post-op
— Mark T.
July 7, 2000
I know this is easy to say, but please don't get too down. This surgery
will happen for you. I'm just sorry you've had such a hard time getting it
done. I have Kaiser and have been waiting for over a year too to get
approved. I was turned down twice before I finally got approved. Still, I
see the surgeon on the 19th and it may be another 2-3 months before I
actually have surgery. The waiting is agony, but I do believe that things
happen for a reason. Most ins. cos. turn people down at least once so
don't give up. By the way, your husband sounds like a peach; I'm so glad
you have that support. Hang in there!
— Darcy B.
July 7, 2000
Hang in there! Your persistence will pay off. Don't give up because
that's exactly what the insurance companies want you to do.
— Paula G.
July 7, 2000
I'm in a similar position, but I'm just in the beginning of the year I have
to wait. My insurance has an exclusion, and I have to wait until next June
to change to Cigna. Please don't give up Ann! And please keep me posted
on your progress with Cigna!
— Gretchen T.
July 7, 2000
I just wanted to say thankyou for everyone today, for their support,
emails,and prayers and thoughts. It was a very hard day, one that seems to
be coming a little to common to me here in the last year. I Will continue
to fight, for to not fight is to let them win. And my life is worth more
then that. Thankyou to all the wonderful people that took the time to let
me know Im not alone....*Hugs* And God Bless!
— Ann A.
July 8, 2000
The is a surgeon in Cleveland at University Hospitals of
Cleveland that will set up a monthly pmt plan for you if your
insurance does not pay for the surgery. They will also appeal
it for you, if you are turned down. His name is Thomas Stellato.
His phone number is: 216 844 3021. Good luck.
— [Anonymous]
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