Insurance Runaround

June 30, 2000

As grandma used to say I'm so angry I could spit.

I think we ought to be able to sue insurance companies for mental suffering

for the deliberate abuse they give us.

On Monday I called CIGNA, my insurance provider, explained that I wanted mgb,

gave them my weight, height and comorbidities. The customer service

representative (whose full name I got) told me that gastric bypass surgery IS

covered for morbid obesity. She also gave me the company fax # that Dr R

should fax his letter to.

I submitted my online form on Monday of this week. Of course I gave Dr R the

CIGNA fax # that the representative gave me.

On Tuesday I called Dr R's office and spoke with Debbie about what the

process would be from there on out.

She suggested that the insurance company would probably refuse to even

consider the letter without at least a " referral for consultation " from my

PCP. At the moment I can't get a full referral due to severe anemia but

there should be no problem getting a referral for consultation.

I immediately faxed a letter to my PCP asking for the referral for

consultation.

In today's, Friday's, mail I received a copy from Dr R of the letter he sent

CIGNA on the same day I sent my online form (Monday).

I immediately called CIGNA to see what their determination was of Dr R's

request. They had the nerve to tell me they hadn't received the letter. The

customer service representative acted a little surprised when I pulled out my

notebook and repeated to her the name, time, date and detailed conversation

that I had with the csr on Monday and the incorrect fax number she gave me.

The csr gave me her fax # plus she gave me the Benefits Review Department's

fax #. I immediately faxed Dr R's letter to both numbers and asked them to

confirm by email that they had received it.

Needless to say 2 hours later I still hadn't received confirmation from them

that they had received it. So I called again and talked to and 3rd csr. At

first she tried to tell me that they had not received any of the 3 faxes sent

to the 3 different fax numbers they had given me. When I gave her everyone's

names, dates, and a rundown on our conversation she put me on hold to " look

into the matter. "

Guess what. Miracle of miracles they found the faxes BUT......

Now (just like Debbie warned me) they won't consider Dr R's letter until my

PCP issues a referral for consultation.

SO - I called my PCP's office and spoke to his clerical person. She said

that the doctor had given his approval for the referral and it was currently

on her desk for her to complete the paperwork for the approval. I asked her

what the referral # was and she said that she was leaving in 30 minutes and

probably wouldn't be able to work on it until Wednesday, July 5.

SO - bright and early July 6 I will be calling my PCP's office to insure they

properly completed the paperwork and then I'll start hounding the insurance

company again.

These people don't realize that I HAVE MADE UP MY MIND AND DAMN IF THEY

AREN'T GOING TO APPROVE THIS ONE WAY OR THE OTHER.

I hope all this helps someone understand the pitfalls, excuses and obstacles

that are presented to us. I hope you learn from my experience.

Bottom line - Dr R and his office seem to really have it together - everyone

else could care less

JC

June 30, 2000

Dear JC,

You have exactly the right attitude! I got the runaround from CIGNA

too. I let them know that I was not going to lose the battle with

them and then became the very large bee up their behind! I called

and emailed repeatedly. I did not go away after an initial denial

either. I wrote a very detailed appeal and won. I'm convinced that

their reps are taught to stall . . . stall . . . stall . . . and then

deny . . . and then stall some more . . . etc... Mostly, I think,

they hope you'll just give up and go away. But when you're as

determined to win as you apparently are, then your chances for

approval are good. More power to you!

Best Wishes,

Kris

> As grandma used to say I'm so angry I could spit.

>

> I think we ought to be able to sue insurance companies for mental

suffering

> for the deliberate abuse they give us.

>

> On Monday I called CIGNA, my insurance provider, explained that I

wanted mgb,

> These people don't realize that I HAVE MADE UP MY MIND AND DAMN IF

THEY

> AREN'T GOING TO APPROVE THIS ONE WAY OR THE OTHER.

>

> I hope all this helps someone understand the pitfalls, excuses and

obstacles

> that are presented to us. I hope you learn from my experience.

>

> Bottom line - Dr R and his office seem to really have it together -

everyone

> else could care less

>

> JC

June 30, 2000