ANOTHER ins. question

[Guest guest]

Hi Guys.

I am sooooo sorry to be asking tons of questions that may seem so trivial or

common sense to some of you, but I am in the process of making my appts. for

my physicals with my OB and etc. in order to have a " recent " /updated record

and such. I have called my ins. (Cigna Healthcare of NC) and asked them

point blank...did they cover weight loss surgery...etc....and of course they

don't.....that was a big a** surprise, (as it has been for most of us,

huh??!?!?!). Ok....well, it says that it doesn't cover it for the

" obese " ...not the " morbidly obese " so I have found what I hope is my first

" loop hole. " I talked to a really nice person in the other end of the phone

this time and I got her name and extension number if I need her again. I

am still moving forward with all my preparations for this surgery...I have a

few " hic-ups " I have to work out with my PCP first...so it might take a

little while, so I continue to plow on.

The question I have is this: While talking to the girl at Cigna, I asked her

what kind of account I had (since we have to put that on our online form) and

she said that I have a straight HMO. Another lady on here, Janice, has

CignaHCofNC and she has a POS plan that seems to be more flexible...she

doesn't have to have referrals and stuff. Well, under my HMO plan, I have to

be referred to pick my nose...I have to be referred for EVERYTHING!!!!!! It

is aggrovating actually. SOOOOOO, do I need to submit my online form to Dr.

R before I get reffered from my PCP to Dr. R's office? I mean, if I send the

form in via the internet, Dr. R sends a letter to Cigna, they will probably

refuse to pay just because I wasn't referred by my PCP before hand (under my

specific plan). See? So, from this point, what do I do? Go ahead and send

in the form to Dr. R and start getting my packet together, or go and see my

PCP first? The reason I ask is because it seems that everyone else has just

sent their form to Dr. R FIRST. I am afraid if I make an appt. w/ my PCP for

a " pre-op " physical, that the ins. will not want to pay for that

either.....(if they don't have prior knowledge of WHY I am needing the pr-op

physical) so in that case, I would need to go ahead with the online info to

Dr. R. Has this question even made any sense to anyone? I am so sorry it

has been long.

I am already getting my appeal letter ready...thanks so DebLaMan...(THANK

YOU). I am ready to fight these old insurance buzzards (as my grandma used

to say). I am getting my stuff together. I am MGB BOUND BABY!!!!! (One

day!!!)

[Guest guest]

In a message dated 7/3/00 10:20:03 PM Pacific Daylight Time,

HNBarnhill@... writes:

<<

I am already getting my appeal letter ready...thanks so DebLaMan...(THANK

YOU). I am ready to fight these old insurance buzzards (as my grandma used

to say). I am getting my stuff together. I am MGB BOUND BABY!!!!! (One

day!!!)

>>

Hi !

You are VERY welcome, I hope the letters help! We also have Cigna HMO and,

yes, you have to be referred, but that referral is just a formality before

surgery. You still can pursue the surgery and insurance coverage without it.

At least that is what we did. Here is the order that I did everything in,

though it is not set in stone that you have to do it this way:

1) Online form submitted

2) (Once I received copy of letter Dr R sent to Cigna)--letter to PCP:

--why surgery was necessary

--what Chris' life is like

--Patient Ed Manual from Dr R

--that we had scheduled an appt to come in and see her

3) (Once Cigna denied)--appeal letter to insurance

4) (Once Cigna denied)--2nd appeal letter from me (considered 3rd appeal,

as Dr R's letter was first) followed up by:

5) Phone contact with Cigna, finally reaching correct Appeal Manager and

getting name of Dr who consults. I spoke with her for 3 days in a row,

until approved.

6) Appt. with PCP who was SHOCKED that we had gotten approval. She was

set to give her approval, but had assumed we would be forced to have the

local " lap guru " do an roux-en-y.

7) Packet in to Dr R

Hope this helps, but as I say, it doesn't HAVE to be in this order, I am

sure. Anyway, this is what got us approved for with Cigna HealthCare

HMO.

Regards,

Debbie in IL

Cigna approved on 3rd appeal for daughter (BMI 45)

Counting on Cigna for Debbie (BMI 40) correct online info re-sent 6/29

[Guest guest]

In a message dated 7/3/00 10:20:03 PM Pacific Daylight Time,

HNBarnhill@... writes:

<<

I am already getting my appeal letter ready...thanks so DebLaMan...(THANK

YOU). I am ready to fight these old insurance buzzards (as my grandma used

to say). I am getting my stuff together. I am MGB BOUND BABY!!!!! (One

day!!!)

>>

Hi !

You are VERY welcome, I hope the letters help! We also have Cigna HMO and,

yes, you have to be referred, but that referral is just a formality before

surgery. You still can pursue the surgery and insurance coverage without it.

At least that is what we did. Here is the order that I did everything in,

though it is not set in stone that you have to do it this way:

1) Online form submitted

2) (Once I received copy of letter Dr R sent to Cigna)--letter to PCP:

--why surgery was necessary

--what Chris' life is like

--Patient Ed Manual from Dr R

--that we had scheduled an appt to come in and see her

3) (Once Cigna denied)--appeal letter to insurance

4) (Once Cigna denied)--2nd appeal letter from me (considered 3rd appeal,

as Dr R's letter was first) followed up by:

5) Phone contact with Cigna, finally reaching correct Appeal Manager and

getting name of Dr who consults. I spoke with her for 3 days in a row,

until approved.

6) Appt. with PCP who was SHOCKED that we had gotten approval. She was

set to give her approval, but had assumed we would be forced to have the

local " lap guru " do an roux-en-y.

7) Packet in to Dr R

Hope this helps, but as I say, it doesn't HAVE to be in this order, I am

sure. Anyway, this is what got us approved for with Cigna HealthCare

HMO.

Regards,

Debbie in IL

Cigna approved on 3rd appeal for daughter (BMI 45)

Counting on Cigna for Debbie (BMI 40) correct online info re-sent 6/29