PANIC STATIONS!

[Guest guest]

This is especially for pre-ops:

Today I received in the mail the usual statement from CIGNA

Healthcare PPO about how much of the tests, etc. I sent in claims for

are covered or not....

My eyes bugged out when I saw this:

$300 consultation Dr Rabkin/Jossart

NOT INCLUDED:

" Charges for treatment or surgery for Obesity, Weight Reduction or

Weight Control are not covered under your plan "

PANIC STATIONS!

I immediately phoned the number provided to question this. First

thing I said was; this was for a surgery consult for MORBID OBESITY

not OBESITY.. and that I know the surgery is covered as long as its

determined to be Medically Necessary, in addition I know the criteria

CIGNA is looking for ...

She put me on hold....a long hold, I was having a huge anxiety attack

at this point and gearing up ready to do battle..... Face flushed...

while pulling up my computer files about the criteria they gave me

etc.... facts in hand.... I was thinking if its going to be this hard

having them cover the consult what is the surgery battle going to be

like!!!

That's when she got back on the line and told me she could see in my

file that;

MY SURGERY WAS APPROVED ON APRIL 25TH AND LETTERS STATING SUCH WOULD

BE IN THE MAIL TO ME AND MY DR! She will now resubmit my consult

claim knowing these facts.....

WHOOPEEEEEEEEEEE!!!!!!

NOTE: to other CIGNA patients: I did **not** include documentation

for 3 medically supervised weight loss programs in my

PREDETERMINATION request - as was suggested one of the times I asked

for LOMN criteria via their web site.

ALSO NOTE: It was confirmed by Cigna that they recieved me refaxed

PREDETERMINATION request on Tues April 23rd (previous one not

recieved), approved on April 25th. So they can act quickly if

provoked. I said numerous times in a previous conversation how

disconcerting it was to get the verifiably wrong information from

three different people in one phone call.

Next thing I did was to call the Drs office in SF and get my surgery

date!:

JUNE 27TH, 2001

YEAH!!!! Surgery approved and I have a date!!! This has been a really

good day!

***Please remember every time you talk to your ins co. 1) Ask for the

person's name, thier extention (and desk number if you have Cigna). 2)

Ask that your phone call be documented.

If you dont.. its like it never happened. They are more likely to do

it if you ask for thier name too!

***Dont assume the Ins co have recieved your LOMN just because the

Drs office says its been faxed. Too many times I've read here that

the Ins co's routinely deny having recieved such faxes. Get a

person's name to have it faxed to. Get a fax number to use and give

it to your Drs office... it will save time and trouble if you do and

will avoid slow snail mail only responses.

mary bmi 68

corona ca

I HAVE A DATE!JUNE 27TH, 2001