Re: Calling all those that insurance denied

[Guest guest]

Ah, a topic so near and dear to me!!

>

> 1. Where are you in the process? (1st denial, 2nd appeal etc...)

I was approved initially by the medical group, denied by the health

plan Cigna. Got a reconsideration. Denied again. Filed an appeal, attended

a hearing and got approved 4 days later!

> 2. How far are you willing to go to get your insurance company to

> pay for the surgery?

They made me so damn made with pretextual denial I would have (and

was planning on) suing them for bad faith.

> 3. How long has this process taken so far?

My consult was June 5, 2000. The denial was in September, after all

the pre-op tests had been approved and completed in August. The hearing was

Nov. 16.

> 4. Will you be able to self-pay if everything else fails?

Nope, no way I could have (we are still paying off my husband's

facial reconstructive surgery for severe sleep apnea from last year!) and

thank God that I won't. This little puppy is being covered 100% (minus a

$10 co-pay).

Kathy P.

Finally approved and may have surgery on 12/6!

[Guest guest]

Ah, a topic so near and dear to me!!

>

> 1. Where are you in the process? (1st denial, 2nd appeal etc...)

I was approved initially by the medical group, denied by the health

plan Cigna. Got a reconsideration. Denied again. Filed an appeal, attended

a hearing and got approved 4 days later!

> 2. How far are you willing to go to get your insurance company to

> pay for the surgery?

They made me so damn made with pretextual denial I would have (and

was planning on) suing them for bad faith.

> 3. How long has this process taken so far?

My consult was June 5, 2000. The denial was in September, after all

the pre-op tests had been approved and completed in August. The hearing was

Nov. 16.

> 4. Will you be able to self-pay if everything else fails?

Nope, no way I could have (we are still paying off my husband's

facial reconstructive surgery for severe sleep apnea from last year!) and

thank God that I won't. This little puppy is being covered 100% (minus a

$10 co-pay).

Kathy P.

Finally approved and may have surgery on 12/6!

[Guest guest]

Terri, I have been denied a dang REFERRAL! Not even the surgery yet. Cigna

has denied all my appeals with one doc, so we have had to start over with

another one. They have taken so long , it looks like I may have to have all

my tests redone. I will go as far as I can with them. I have, my PCP and

local RNY surgeon has been in contact with Cigna. I have no idea how far Dr.

has gotten with them, or even if he has tried. I have been in contact

with my local insurance commisioner and filed a complaint against Cigna. My

husbands HR department is now also involved. I am hoping that they can do

something. I started all this in May of this year and no, there is no way I

can self pay. I will just have to die fat :-(

Calling all those that insurance denied

>

> How are all the insurance denials doing. Where are you at in the

> fight.

>

> 1. Where are you in the process? (1st denial, 2nd appeal etc...)

> 2. How far are you willing to go to get your insurance company to

> pay for the surgery?

> 3. How long has this process taken so far?

> 4. Will you be able to self-pay if everything else fails?

>

>

> Teri

> BMI 50

> Been denied twice/ waiting the final decision for over 60 days, no

> word yet.

>

>

>

>

[Guest guest]

Terri, I have been denied a dang REFERRAL! Not even the surgery yet. Cigna

has denied all my appeals with one doc, so we have had to start over with

another one. They have taken so long , it looks like I may have to have all

my tests redone. I will go as far as I can with them. I have, my PCP and

local RNY surgeon has been in contact with Cigna. I have no idea how far Dr.

has gotten with them, or even if he has tried. I have been in contact

with my local insurance commisioner and filed a complaint against Cigna. My

husbands HR department is now also involved. I am hoping that they can do

something. I started all this in May of this year and no, there is no way I

can self pay. I will just have to die fat :-(

Calling all those that insurance denied

>

> How are all the insurance denials doing. Where are you at in the

> fight.

>

> 1. Where are you in the process? (1st denial, 2nd appeal etc...)

> 2. How far are you willing to go to get your insurance company to

> pay for the surgery?

> 3. How long has this process taken so far?

> 4. Will you be able to self-pay if everything else fails?

>

>

> Teri

> BMI 50

> Been denied twice/ waiting the final decision for over 60 days, no

> word yet.

>

>

>

>

[Guest guest]

Kathy, thank God thank God thank God they finally approved you!

Where are you from? Was your Cigna hmo or ppo?

Re: Calling all those that insurance denied

> Ah, a topic so near and dear to me!!

> >

> > 1. Where are you in the process? (1st denial, 2nd appeal etc...)

> I was approved initially by the medical group, denied by the

health

> plan Cigna. Got a reconsideration. Denied again. Filed an appeal,

attended

> a hearing and got approved 4 days later!

>

> > 2. How far are you willing to go to get your insurance company to

> > pay for the surgery?

> They made me so damn made with pretextual denial I would have (and

> was planning on) suing them for bad faith.

>

> > 3. How long has this process taken so far?

> My consult was June 5, 2000. The denial was in September, after

all

> the pre-op tests had been approved and completed in August. The hearing

was

> Nov. 16.

>

> > 4. Will you be able to self-pay if everything else fails?

> Nope, no way I could have (we are still paying off my husband's

> facial reconstructive surgery for severe sleep apnea from last year!) and

> thank God that I won't. This little puppy is being covered 100% (minus a

> $10 co-pay).

>

> Kathy P.

> Finally approved and may have surgery on 12/6!

>

>

>

>

[Guest guest]

Kathy, thank God thank God thank God they finally approved you!

Where are you from? Was your Cigna hmo or ppo?

Re: Calling all those that insurance denied

> Ah, a topic so near and dear to me!!

> >

> > 1. Where are you in the process? (1st denial, 2nd appeal etc...)

> I was approved initially by the medical group, denied by the

health

> plan Cigna. Got a reconsideration. Denied again. Filed an appeal,

attended

> a hearing and got approved 4 days later!

>

> > 2. How far are you willing to go to get your insurance company to

> > pay for the surgery?

> They made me so damn made with pretextual denial I would have (and

> was planning on) suing them for bad faith.

>

> > 3. How long has this process taken so far?

> My consult was June 5, 2000. The denial was in September, after

all

> the pre-op tests had been approved and completed in August. The hearing

was

> Nov. 16.

>

> > 4. Will you be able to self-pay if everything else fails?

> Nope, no way I could have (we are still paying off my husband's

> facial reconstructive surgery for severe sleep apnea from last year!) and

> thank God that I won't. This little puppy is being covered 100% (minus a

> $10 co-pay).

>

> Kathy P.

> Finally approved and may have surgery on 12/6!

>

>

>

>

[Guest guest]

Sherri:

Cigna of Southern California HMO. They have been assholes the whole

way through. For awhile they tried to claim that I didn't even HAVE their

blasted insurance! Cigna all over the country has been a problem. Why

won't they approve a referral? Is the trouble your PCP or the medical

group? My old PCP wouldn't refer me to Dr. Anthone at USC because he said

that the medical group would never approve it - they had someone in the

group who does RnY and that was my only option. So I switched PCPs and

medical groups. Keep at them. Are they saying that it isn't a covered

benefit? Please let me help!

Kathy P.

Re: Calling all those that insurance denied

>

>

> > Ah, a topic so near and dear to me!!

> > >

> > > 1. Where are you in the process? (1st denial, 2nd appeal etc...)

> > I was approved initially by the medical group, denied by the

> health

> > plan Cigna. Got a reconsideration. Denied again. Filed an appeal,

> attended

> > a hearing and got approved 4 days later!

> >

> > > 2. How far are you willing to go to get your insurance company to

> > > pay for the surgery?

> > They made me so damn made with pretextual denial I would have

(and

> > was planning on) suing them for bad faith.

> >

> > > 3. How long has this process taken so far?

> > My consult was June 5, 2000. The denial was in September, after

> all

> > the pre-op tests had been approved and completed in August. The hearing

> was

> > Nov. 16.

> >

> > > 4. Will you be able to self-pay if everything else fails?

> > Nope, no way I could have (we are still paying off my husband's

> > facial reconstructive surgery for severe sleep apnea from last year!)

and

> > thank God that I won't. This little puppy is being covered 100% (minus

a

> > $10 co-pay).

> >

> > Kathy P.

> > Finally approved and may have surgery on 12/6!

> >

> >

> >

> >

>

>

>

>

>

[Guest guest]

Sherri:

Cigna of Southern California HMO. They have been assholes the whole

way through. For awhile they tried to claim that I didn't even HAVE their

blasted insurance! Cigna all over the country has been a problem. Why

won't they approve a referral? Is the trouble your PCP or the medical

group? My old PCP wouldn't refer me to Dr. Anthone at USC because he said

that the medical group would never approve it - they had someone in the

group who does RnY and that was my only option. So I switched PCPs and

medical groups. Keep at them. Are they saying that it isn't a covered

benefit? Please let me help!

Kathy P.

Re: Calling all those that insurance denied

>

>

> > Ah, a topic so near and dear to me!!

> > >

> > > 1. Where are you in the process? (1st denial, 2nd appeal etc...)

> > I was approved initially by the medical group, denied by the

> health

> > plan Cigna. Got a reconsideration. Denied again. Filed an appeal,

> attended

> > a hearing and got approved 4 days later!

> >

> > > 2. How far are you willing to go to get your insurance company to

> > > pay for the surgery?

> > They made me so damn made with pretextual denial I would have

(and

> > was planning on) suing them for bad faith.

> >

> > > 3. How long has this process taken so far?

> > My consult was June 5, 2000. The denial was in September, after

> all

> > the pre-op tests had been approved and completed in August. The hearing

> was

> > Nov. 16.

> >

> > > 4. Will you be able to self-pay if everything else fails?

> > Nope, no way I could have (we are still paying off my husband's

> > facial reconstructive surgery for severe sleep apnea from last year!)

and

> > thank God that I won't. This little puppy is being covered 100% (minus

a

> > $10 co-pay).

> >

> > Kathy P.

> > Finally approved and may have surgery on 12/6!

> >

> >

> >

> >

>

>

>

>

>

[Guest guest]

Well honey, help away! :-)

Cigna's problem is that Dr. is in Georgia and I am in Tennessee. They

want me to go to a doc in Tennessee, which there aren't any in Tennessee

that do the DS. They think there are. They keep giving me phone numbers to

docs, I call them and verify they do NOT do the DS, call Cigna back etc....

They are evil. pure and simple.

Re: Calling all those that insurance denied

> >

> >

> > > Ah, a topic so near and dear to me!!

> > > >

> > > > 1. Where are you in the process? (1st denial, 2nd appeal etc...)

> > > I was approved initially by the medical group, denied by the

> > health

> > > plan Cigna. Got a reconsideration. Denied again. Filed an appeal,

> > attended

> > > a hearing and got approved 4 days later!

> > >

> > > > 2. How far are you willing to go to get your insurance company to

> > > > pay for the surgery?

> > > They made me so damn made with pretextual denial I would have

> (and

> > > was planning on) suing them for bad faith.

> > >

> > > > 3. How long has this process taken so far?

> > > My consult was June 5, 2000. The denial was in September,

after

> > all

> > > the pre-op tests had been approved and completed in August. The

hearing

> > was

> > > Nov. 16.

> > >

> > > > 4. Will you be able to self-pay if everything else fails?

> > > Nope, no way I could have (we are still paying off my

husband's

> > > facial reconstructive surgery for severe sleep apnea from last year!)

> and

> > > thank God that I won't. This little puppy is being covered 100%

(minus

> a

> > > $10 co-pay).

> > >

> > > Kathy P.

> > > Finally approved and may have surgery on 12/6!

> > >

> > >

> > >

> > >

> >

> >

> >

> >

> >

>

>

>

[Guest guest]

Hi Teri - I was denied by Prudential POS (my 15 year old thouhgt that that

POS was an editorial comment!!!) I'm switching rather than fighting...my

insurance contract is almost up so we're trying to switch to United Health

Care POS, which seems to be DS friendly and the same price. Yes, if I must I

will do self pay..but I'm very hopeful about United Health Care.... W.

[Guest guest]

>

> How are all the insurance denials doing. Where are you at in the

> fight.

>

> 1. Where are you in the process? (1st denial, 2nd appeal etc...)

Denied twice

> 2. How far are you willing to go to get your insurance company

to

> pay for the surgery?

Prepared to sue, however since my insurance is a self funded plan I

will pretty much be suing my husband's employer in the end. This

worries me alot.

> 3. How long has this process taken so far?

It has taken way too long. My LOMN requesting authorization for

surgery was sent in the end of April. Here I sit 7 months later

still waiting.

> 4. Will you be able to self-pay if everything else fails?

No. If I can't get insurance to cover the surgery even after suing

then I won't be able to have it.

Good luck Teri.

Sheila