Cigna/Denied

[Guest guest]

Hi, everyone. I was just denied by Cigna for the ds for the following

reasons... " Dr. Keshishian is not a Cigna HealthCare HMO Provider and your

coverage plan does not have an out-of-network option. "

I plan to appeal based on the fact that my choice of surgeons in California

are limited to three individuals, with Dr. K being the closest one to me. I

am not choosing him out of " personal preference " , although I do like him. I

am simply choosing to have the DS procedure at the location nearest to me.

It's been implied that if I were getting the Roux-n-Y procedure, I would have

several providers to choose from and all would be well. However, I want the

DS...therein lies the hangup, I guess.

The part I don't really know how to get around is the " out of network "

option. Cigna does not offer individuals anything other than HMO services. I

can't upgrade at all. As for other insurances, the Major Risk insurance plans

in California have waiting lists of18 plus months (you just wait until

someone dies, essentially.) Has anyone out there appealed based on these

denials or denials similar to these?

Also, has anyone appealed Cigna's first decision in general? Do they just

automatically deny everyone and then weed them out during appeals? Any

insight would be greatly appreciated.

THANKS SO MUCH!

in California

[Guest guest]

,

Hey! We are in the same boat! I was also denied by Cigna hmo for the

ds for dr k. (of course it also said I didnt meet critera, but I

do...)

I have had no luck yet so I am really no help. I has told by cigna

that if there are no in network providers for the ds, (and I can prove

that I have to have the ds over the rny) that they will pay for out of

network coverage. (to make matters worse I live in az) In az there are

only two in network providers and both only do the rny....

Keep in touch if you or anyone know of anything that may help my

e-mail is ann85234@...

Ann

Still in Cigna Hell!

> Hi, everyone. I was just denied by Cigna for the ds for the

following

> reasons... " Dr. Keshishian is not a Cigna HealthCare HMO Provider and

your

> coverage plan does not have an out-of-network option. "

>

> I plan to appeal based on the fact that my choice of surgeons in

California

> are limited to three individuals, with Dr. K being the closest one

to me. I

> am not choosing him out of " personal preference " , although I do like

him. I

> am simply choosing to have the DS procedure at the location nearest

to me.

> It's been implied that if I were getting the Roux-n-Y procedure, I

would have

> several providers to choose from and all would be well. However, I

want the

> DS...therein lies the hangup, I guess.

>

> The part I don't really know how to get around is the " out of

network "

> option. Cigna does not offer individuals anything other than HMO

services. I

> can't upgrade at all. As for other insurances, the Major Risk

insurance plans

> in California have waiting lists of18 plus months (you just wait

until

> someone dies, essentially.) Has anyone out there appealed based on

these

> denials or denials similar to these?

>

> Also, has anyone appealed Cigna's first decision in general? Do they

just

> automatically deny everyone and then weed them out during appeals?

Any

> insight would be greatly appreciated.

>

> THANKS SO MUCH!

> in California