Guest guest Posted April 28, 2001 Report Share Posted April 28, 2001 So happy for you, ! Congratulations on your date! > > YEAH!!!! Surgery approved and I have a date!!! This > has been a really > good day! > ===== Age 41 BMI 61 Consult 6/7/01 Dr. Herron __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2001 Report Share Posted April 28, 2001 Congrats!!! Often times it is just as you say, a difficult road to hoe with the insurance companies - but guess what - you won!!! I just had my surgery with Dr. Rabkin on 3/15/01 - you are in good hands! --- waterlilys@... wrote: > > 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 > > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 30, 2001 Report Share Posted April 30, 2001 , I was glad to hear that they did not ask for proof of 3 medicaly supervised diets. I have been stressing about that! I also noticed that you went with rapkin. Isn't he that one that makes you pre-pay and then lets insurance pay you back? How does that work...? Ann Pre-op AZ Cigna Hmo > > 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 Quote Link to comment Share on other sites More sharing options...
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