Cigna

[Guest guest]

I have CIGNA HealthCare of NC administrators,and they are giving me the run

around. I have just called them to see if they have received my preapproval

and they can not tell me anything unless it is a denial or approval they

can't say if they have gotten it. They say to call the Doctor back and see if

he has heard anything. Can you believe that one. I can't know but I am the

one insured isn't that nice. So I guess I will have to call the Doc's office

tomorrow and see what they say, unless anyone has any ideas. Ok well I guess

the good news is at least it is not a denial. I hope you have some luck

dealing with them. Sorry to be such a downer but I have been trying to get

some kind of info on it it was sent off july 28.

hugs and slugs,

marg omg 290 now can u believe I am growing

[Guest guest]

Thanks , I will email Debbie now and do the same thing. I am the same if

they don't approve I will put it on my credit card lol or something. Keep me

posted on what happens with you. hugs and slugs marg

[Guest guest]

Cigna is just giving you a hard time. I had the same problem. They finally

on the 4th attempt using the 4th fax number that they gave me - finally they

acknowledged that they had received it. The last 3 times I handled the

sending of the fax myself. So if they accepted it from me there is

ABSOLUTELY no reason why they should not accept it from you.

I suggest you call Terri Coenig with Cigna. Barbara (with Dr. R's office)

recommended her as someone who had been helpful in the past. Terri's number

is 1- ext 7618 - fax # . She is very nice. I think

she can help you.

Janice

[Guest guest]

Ok here is update on the Cigna saga: I called Terri and she said that really

the Doc office should be handling all of this and that is why we are getting

the run around.OK Now did they receive my fax from the doctor NO. So she is

going to call Doc office and have them resend, because they can not except

fax from patients also they can not pre cert until Doctor has seen. Ok. Now

there is a exclusion in our policy for weight loss surgery not specificly

Mini gastric bypass, but generally no weight loss anything. So she says that

it will not be covered and I should get with the human resource people from

my husbands company. I said even if it is a medical neccessity she said any.

But as soon as they receive the fax they will send a denial and then I can

appeal but will probably get me no where. So if anyone has the appeal letter

Please send me one that has worked. Also any one with any suggestions. I have

medicare also but now Doc doesn't take that either so I am sitting here

wondering what to do. feel like goin to bed an crying : ( marg

[Guest guest]

Sorry for your troubles.Take the nite off and regroup in the morning. BEs

twishes.

Kathie265

[Guest guest]

Keep me posted on what happens I am sorry this is happening to you also. They

pay for people with anerexia but not for life saving surgery for the obese.

hugs marg

[Guest guest]

Marg:

I was denied by Cigna on all appeals. I had a great appeal letter,

my benefits manager thought it was the best they have ever seen. Dr.

R. letter was sent with it. When they got Dr. R's letter and I spoke

to Cigna, the comment was " Oh another Rutledge appeal, we're familiar

with him, he just changes the name. I even hired a lawyer and he

wrote an appeal and represented me at my hearing. The day after my

appeal on June 2nd I received a letter dated June 2nd that Cigna was

still denying the surgery. They didn't even give it much thought.

They said this was not a medical appeal but an administrative one

because WLS is clearly excluded. All the appeal letters clearly

stated that Cigna's clause mentioned obesity not " morbid obesity "

which is what we suffer from. Now I am waiting for my lawyer to send

a complaint to the NC insurance commission. I am not hopeful that it

will be overturned because they just look at whether Cigna followed

the policy and the appeal process as outlined. I am working with my

Benefits manager to either have Cigna's contracts language changed

for next year or change insurance companys. I cannot afford to self

pay, and if I could and there were complications Cigna has a clause

stating they won't pay for complications caused by a procedure they

denied. Sorry for venting, I know you were looking for

encouragement, I haven't given up hope....maybe all of us being

denied by Cigna should get a class action suit against them going. I

don't know how to go about that? But I will do anything to have this

surgery and I think they should pay we are their customers. ,

MGB hopeful since 2/19 BMI 53 (and rising)

> Ok here is update on the Cigna saga: I called Terri and she said

that really

> the Doc office should be handling all of this and that is why we

are getting

> the run around.OK Now did they receive my fax from the doctor NO.

So she is

> going to call Doc office and have them resend, because they can not

except

> fax from patients also they can not pre cert until Doctor has seen.

Ok. Now

> there is a exclusion in our policy for weight loss surgery not

specificly

> Mini gastric bypass, but generally no weight loss anything. So she

says that

> it will not be covered and I should get with the human resource

people from

> my husbands company. I said even if it is a medical neccessity she

said any.

> But as soon as they receive the fax they will send a denial and

then I can

> appeal but will probably get me no where. So if anyone has the

appeal letter

> Please send me one that has worked. Also any one with any

suggestions. I have

> medicare also but now Doc doesn't take that either so I am sitting

here

> wondering what to do. feel like goin to bed an crying : ( marg

[Guest guest]

,

I have CignaHealthcare. It is a group policy as a result of my husband's

status as a retiree with E. I. Dupont de Nemours. The group number is

NCDUP4.

Per Cigna I have a " Point of Service Plan " which means I can go out of

network. " But that doesn't matter because Dr. Rutledge is an approved

in-network consultant specialist. Per Cigna my policy states " Gastric

Stapling and Gastric Bypass Surgery for Morbid Obesity IS covered "

Janice

[Guest guest]

Have you had any problems getting approved?

So far, all the replies I've received have involved Cigna as a plan

administrator for a self-insured company.

That means they are under some *very* specific legal duties, mandated by

federal law, that can make them tow the line if the issue is raised.

It also means that people can also try to get the company to override

whatever Cigna says and agree to cover it.

appraiseca@... wrote:

>

> ,

>

> I have CignaHealthcare. It is a group policy as a result of my husband's

> status as a retiree with E. I. Dupont de Nemours. The group number is

> NCDUP4.

>

> Per Cigna I have a " Point of Service Plan " which means I can go out of

> network. " But that doesn't matter because Dr. Rutledge is an approved

> in-network consultant specialist. Per Cigna my policy states " Gastric

> Stapling and Gastric Bypass Surgery for Morbid Obesity IS covered "

>

> Janice

>

>

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

> To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

[Guest guest]

Well it took 4 separate fax numbers (all from Cigna) before we finally got

Dr. R's request letter faxed to them. Then they never responded back to me.

I kept calling. Then they said they needed me to have a visit with Dr. R

before they would consider giving prior approval.

I went to his 07-18-00 clinic and had a consultation. Then they said they

need all the info from the clinic. Then they said they needed additional

info but couldn't tell me what it was.

Now they say they need more proof from my PCP of " previous conservative

treatment for weight loss " (i.e. diets, exercise, weight loss medications)

and a more clearly defined referral from my PCP. All doctors who have

treated me for weight-related illnesses and supervised any conservative

treatment have sent further info to Cigna. I'm still waiting for a

determination.

In the meanwhile I am very anemic and am attempting to get to the source of

my anemia. I have a complete GI series (upper and lower) schedule next

Wednesday. Hopefully all things will come together, my GI series will be

negative, my blood will miraculously become normal, I'll be approved for

insurance coverage and I'll have the surgery by October - my target date.

Wish me luck

janice

[Guest guest]

Janice,

I hope the upper GI comes out ok. I will be praying and fingers crossed so u

can have surgery on the day u want. love and hugs marg

[Guest guest]

Marg, I was so saddened by your post.You have been so friendly to me

and everyone on this list.My prayers are with you. Janet

>From: mmhammy@...

>Reply-To: MiniGastricBypass (AT) egroups (DOT) com

>To: MiniGastricBypass (AT) egroups (DOT) com

>Subject: Re: Cigna

>Date: Tue, 15 Aug 2000 16:39:38 EDT

>

>Ok here is update on the Cigna saga: I called Terri and she said that

>really

>the Doc office should be handling all of this and that is why we are

>getting

>the run around.OK Now did they receive my fax from the doctor NO. So she is

>going to call Doc office and have them resend, because they can not except

>fax from patients also they can not pre cert until Doctor has seen. Ok. Now

>there is a exclusion in our policy for weight loss surgery not specificly

>Mini gastric bypass, but generally no weight loss anything. So she says

>that

>it will not be covered and I should get with the human resource people from

>my husbands company. I said even if it is a medical neccessity she said

>any.

>But as soon as they receive the fax they will send a denial and then I can

>appeal but will probably get me no where. So if anyone has the appeal

>letter

>Please send me one that has worked. Also any one with any suggestions. I

>have

>medicare also but now Doc doesn't take that either so I am sitting here

>wondering what to do. feel like goin to bed an crying : ( marg

________________________________________________________________________

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[Guest guest]

,

I understand what you mean by the company can overide if they are

self-insured but what do you mean by the ins. co. are under some

*very* specific legal duties, mandated by fed. law, that can make

them tow the line if the issue is raised?

Thanks for all your advice and I LOVE your website!!

in Charlotte

[Guest guest]

Gould wrote:

>

> ,

>

> I understand what you mean by the company can overide if they are

> self-insured but what do you mean by the ins. co. are under some

> *very* specific legal duties, mandated by fed. law, that can make

> them tow the line if the issue is raised?

A federal law known as ERISA requires that they observe certain specfic

duties in their administration of insurance plans and they can be sued

for breaching those duties. The standard is very high, because they are

considered to be " trustees. "

Just for example, if they delay just to delay, that can be sued as a

breach of their duty as a trustee.

>

> Thanks for all your advice and I LOVE your website!!

>

> in Charlotte

>

>

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

> To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

[Guest guest]

In a message dated 8/16/00 1:36:55 PM Pacific Daylight Time,

lindat@... writes:

<< All of you that have CIGNA let me know *which* CIGNA you have (which

state, what kind of policy). I'm working on a CIGNA claim right now and

yes, they are a pain in the butt.

>>

Hi ,

We have Cigna HMO, Illinois. I must say, though, that I found them (the IL

people, at least) to be WONDERFUL and compassionate!

Regards,

Debbie in IL

MGB 8/10 Cigna approved as " in network "

[Guest guest]

So far, it seems to be CIGNA in Va. that's the prob.

DebLaMan@... wrote:

>

> In a message dated 8/16/00 1:36:55 PM Pacific Daylight Time,

> lindat@... writes:

>

> << All of you that have CIGNA let me know *which* CIGNA you have (which

> state, what kind of policy). I'm working on a CIGNA claim right now and

> yes, they are a pain in the butt.

>

>

> >>

> Hi ,

> We have Cigna HMO, Illinois. I must say, though, that I found them (the IL

> people, at least) to be WONDERFUL and compassionate!

>

> Regards,

> Debbie in IL

> MGB 8/10 Cigna approved as " in network "

>

>

>

> This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

> Please visit our web site at http://clos.net

> Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

> To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

[Guest guest]

Wmson@... wrote:

>

> I have CIGNA PPO - my husband's employer is Republic. I am still

> waiting....and waiting.....and waiting. No decision has been made yet.

>

> on

What state?

[Guest guest]

Dear ,

I had Cigna and they covered my MGB on 7/19/00. You just have

to call them everyday. I am not kidding. They are S----L----O----W

Keep bugging them till you find a sympathetic ear.

Love,

T.

> >

> > I have CIGNA PPO - my husband's employer is Republic. I am still

> > waiting....and waiting.....and waiting. No decision has been

made yet.

> >

> > on

>

> What state?

[Guest guest]

--- Betty:

I worked at HCC Vanguard from 1990-1995 then moved over to the Mt.

Holly manufacturing site in 95 and am still here. I am still part of

the Surfactants group under Clariant. Most of the people I interact

with are the old Hoechst Group. Which group did you work in? I don't

know if you know Elsie Young in accounting, we are great friends she

went to DyStar. Boy do I wish we still had Atena, it seems that

they approve easier than Cigna. I guess it really is a small world,

now I just wish I could get smaller. Rozycki, Denver, NC

In MiniGastricBypass (AT) egroups (DOT) com, " and Betty Harrill "

<bettyjohn@b...> wrote:

> I have lost an email. Someone wrote that they live in North

Carolina and

> are having trouble with their insurance through Clariant. Is that

Clariant

> in Charlotte?

>

> I worked for Hoechst Celanese in Charlotte at Vanguard before they

merged

> with Clariant and most of my fellow workers went with Clariant.

>

> Thanks, Betty in Western NC

[Guest guest]

No. Carolina is a problem also.

-- In MiniGastricBypass (AT) egroups (DOT) com, <lindat@m...>

wrote:

> Wmson@a... wrote:

> >

> > I have CIGNA PPO - my husband's employer is Republic. I am still

> > waiting....and waiting.....and waiting. No decision has been

made yet.

> >

> > on

>

> What state?

[Guest guest]

,

Cigna in NC is a problem also.

in Charlotte

[Guest guest]

Hi ,

Wow, this IS a small world. I got to Vanguard in 95 from HCC in Shelby to

work with Don Lisman's Esha group. Took that package in 97 then went for a

year at DRP with a purchasing group temporarily. Then home. I drove 54

miles a day each way from Forest City.

Yep, I wish we had Aetna again. Personally I never had the first problem

with them over the years.

Lots of luck with Cigna. Betty in Western NC

Re: Cigna

>--- Betty:

>

>I worked at HCC Vanguard from 1990-1995 then moved over to the Mt.

>Holly manufacturing site in 95 and am still here. I am still part of

>the Surfactants group under Clariant. Most of the people I interact

>with are the old Hoechst Group. Which group did you work in? I don't

>know if you know Elsie Young in accounting, we are great friends she

>went to DyStar. Boy do I wish we still had Atena, it seems that

>they approve easier than Cigna. I guess it really is a small world,

>now I just wish I could get smaller. Rozycki, Denver, NC

>

>In MiniGastricBypass (AT) egroups (DOT) com, " and Betty Harrill "

><bettyjohn@b...> wrote:

>> I have lost an email. Someone wrote that they live in North

>Carolina and

>> are having trouble with their insurance through Clariant. Is that

>Clariant

>> in Charlotte?

>>

>> I worked for Hoechst Celanese in Charlotte at Vanguard before they

>merged

>> with Clariant and most of my fellow workers went with Clariant.

>>

>> Thanks, Betty in Western NC

>

>

>

>

>This message is from the Mini-Gastric Bypass Mailing List at Onelist.com

>Please visit our web site at http://clos.net

>Get the Patient Manual at http://clos.net/get_patient_manual.htm

>

>To Unsubscribe Send and Email to:

MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

>

>

[Guest guest]

I just wanted to post the Good new about cigna. I sent my letter to get

approved on Friday 13th and then i called on Monday and told them my dr

mailed off the letter for approval and I know sometimes letters will float

around for weeks and never get into anyones hands so I asked if I could fax

it to anyones attn and make sure it gets in the right hands. So today thurs

4days later I am approved. So CIGNA people dont give up.

[Guest guest]

Great news for you. Hearing so many Cigna folks getting approved is

great news. Can I ask you...What type of policy did you have. Was

WLS listed as an exclusion? Good luck to you. MGB hopeful

since 2/19

> I just wanted to post the Good new about cigna. I sent my letter

to get

> approved on Friday 13th and then i called on Monday and told them

my dr

> mailed off the letter for approval and I know sometimes letters

will float

> around for weeks and never get into anyones hands so I asked if I

could fax

> it to anyones attn and make sure it gets in the right hands. So

today thurs

> 4days later I am approved. So CIGNA people dont give up.

[Guest guest]

hey linda where do u live again. sounds like your husband works for same

company as mine. hugs and slugs marg