Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 , I'm so sorry to hear about the difficulties you are encountering with Cigna. I can only imagine how frustrating it is to go through all the hassle of braces only to find out you can do the treatment only half way. I don't have Cigna but in order to have my insurance cover the cost of the surgery I had my doctor write out a letter which specifically explained the problems i was suffering as a result of my jaw problem e.g. TMJ, difficulty masticating etc.The letter explained the exact procedure my surgeon proposed for me and how this would alleviate my problem. Essentially it demonstrated that I was doing the surgery for non-cosmetic reasons. Now, since my insurance is in Italy I have no idea if this sort of approach would hack it here in N. America. I would relook at what was written in the insurance forms filled out to request for the surgery to be covered and examine whether it is evident that the surgery is for medical reasons rather than cosmetic. I might be over simplifying all of this, as I'm guessing since you mentioned that you appealed that you've already been through all of this. If so, I'm so sorry I can't be of more help. Good luck! Sara > I just received a letter from my surgeon saying even after the appeal > Cigna is saying they will not cover any costs of the insurance. They > are telling me it will be almost $20K to do the surgery which is not > very feasible at this point. I wish I had known this before we put the > braces on and started this process. I probably would have just opted > not to do it at all. > > Any ideas of ways to convince Cigna that this is not a cosmetic > procedure? > > > VERY frustrated at the moment Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2005 Report Share Posted April 28, 2005 I have Cigna through my job and they covered my hospital stay. They did not cover the surgeon's fees since he is out of network and I have an HMO. The way I got it passes was by having my surgeon's coordinator call to get it authorized. Everytime someone would tell her no, she would be asked to be transferred to someone else. Eventually, she found someone that understood the procedure and the medical necessity of it and it was authorized. I would keep filing appeals until they pass it. --- Sara wrote: > , > > I'm so sorry to hear about the difficulties you are > encountering with > Cigna. I can only imagine how frustrating it is to > go through all the > hassle of braces only to find out you can do the > treatment only half > way. I don't have Cigna but in order to have my > insurance cover the > cost of the surgery I had my doctor write out a > letter which > specifically explained the problems i was suffering > as a result of my > jaw problem e.g. TMJ, difficulty masticating etc.The > letter explained > the exact procedure my surgeon proposed for me and > how this would > alleviate my problem. Essentially it demonstrated > that I was doing the > surgery for non-cosmetic reasons. Now, since my > insurance is in Italy I > have no idea if this sort of approach would hack it > here in N. America. > I would relook at what was written in the insurance > forms filled out to > request for the surgery to be covered and examine > whether it is evident > that the surgery is for medical reasons rather than > cosmetic. I might > be over simplifying all of this, as I'm guessing > since you mentioned > that you appealed that you've already been through > all of this. If so, > I'm so sorry I can't be of more help. > > Good luck! > Sara > > > > I just received a letter from my surgeon saying > even after the appeal > > Cigna is saying they will not cover any costs of > the insurance. They > > are telling me it will be almost $20K to do the > surgery which is not > > very feasible at this point. I wish I had known > this before we put > the > > braces on and started this process. I probably > would have just opted > > not to do it at all. > > > > Any ideas of ways to convince Cigna that this is > not a cosmetic > > procedure? > > > > > > VERY frustrated at the moment > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 Yes, it was my thought they would cover the hospital stay since my husband works for the company that owns the hospital where the surgery will be done. But my surgeons coordinator said that if they don't cover the Dr. doing the surgery that they won't cover anything. Does not make sense to me. I hate dealing with insurance companies!! > > > I just received a letter from my surgeon saying > > even after the appeal > > > Cigna is saying they will not cover any costs of > > the insurance. They > > > are telling me it will be almost $20K to do the > > surgery which is not > > > very feasible at this point. I wish I had known > > this before we put > > the > > > braces on and started this process. I probably > > would have just opted > > > not to do it at all. > > > > > > Any ideas of ways to convince Cigna that this is > > not a cosmetic > > > procedure? > > > > > > > > > VERY frustrated at the moment > > > > > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 Hi, I had Cigna at my last job. The approved my orthognathic surgery in summer 2003, so I went ahead with braces, but they changed policy 1/1/05 so that the only surgery they now cover is to have wisdom teeth removed. I don't know how that can really be, since there are so many different problems that people need oral surgery for. It looked like they would pay for my hospital stay, but not the surgeon's fees. I'm not sure how I got approval for that much, but I did have my surgeon write letters stating the medical necessity -- maybe that did it? But it still would have been around $12,000 for the surgeon anyway. I'm hoping that I have better luck with the insurance through my new job -- this insurance problem was a big part of why I decided to switch jobs. I could have put up with hating my job if I knew at least it was providing me with the insurance I need. How can insurance companies turn down people for a procedure that is proven to be necessary? Because it's not life threatening? This stuff makes me angry -- I hope it works out for you! - > >Reply-To: orthognathicsurgerysupport >To: orthognathicsurgerysupport >Subject: Re: [Orthognathic Surgery Support ] Re: Anyone able to convince >Cigna to pay for the surgery? >Date: Thu, 28 Apr 2005 18:55:25 -0700 (PDT) > >I have Cigna through my job and they covered my >hospital stay. They did not cover the surgeon's fees >since he is out of network and I have an HMO. The way >I got it passes was by having my surgeon's coordinator >call to get it authorized. Everytime someone would >tell her no, she would be asked to be transferred to >someone else. Eventually, she found someone that >understood the procedure and the medical necessity of >it and it was authorized. I would keep filing appeals >until they pass it. >--- Sara wrote: > > , > > > > I'm so sorry to hear about the difficulties you are > > encountering with > > Cigna. I can only imagine how frustrating it is to > > go through all the > > hassle of braces only to find out you can do the > > treatment only half > > way. I don't have Cigna but in order to have my > > insurance cover the > > cost of the surgery I had my doctor write out a > > letter which > > specifically explained the problems i was suffering > > as a result of my > > jaw problem e.g. TMJ, difficulty masticating etc.The > > letter explained > > the exact procedure my surgeon proposed for me and > > how this would > > alleviate my problem. Essentially it demonstrated > > that I was doing the > > surgery for non-cosmetic reasons. Now, since my > > insurance is in Italy I > > have no idea if this sort of approach would hack it > > here in N. America. > > I would relook at what was written in the insurance > > forms filled out to > > request for the surgery to be covered and examine > > whether it is evident > > that the surgery is for medical reasons rather than > > cosmetic. I might > > be over simplifying all of this, as I'm guessing > > since you mentioned > > that you appealed that you've already been through > > all of this. If so, > > I'm so sorry I can't be of more help. > > > > Good luck! > > Sara > > > > > > > I just received a letter from my surgeon saying > > even after the appeal > > > Cigna is saying they will not cover any costs of > > the insurance. They > > > are telling me it will be almost $20K to do the > > surgery which is not > > > very feasible at this point. I wish I had known > > this before we put > > the > > > braces on and started this process. I probably > > would have just opted > > > not to do it at all. > > > > > > Any ideas of ways to convince Cigna that this is > > not a cosmetic > > > procedure? > > > > > > > > > VERY frustrated at the moment > > > > > > > > > >__________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 29, 2005 Report Share Posted April 29, 2005 My insurance (which is not Cigna) also provides that I can request a review by a panel of oral and maxillofacial surgeons. I had no trouble with them on my surgery, but did have to file such a request on a procedure my husband had to have. It worked like a charm (my surgeon had told me what to do.) In any case, you could ask. Even if they don't agree, it doesn't hurt to try. And the OMSes should know exactly what's up. Best, Cammie > > > I just received a letter from my surgeon saying > > even after the appeal > > > Cigna is saying they will not cover any costs of > > the insurance. They > > > are telling me it will be almost $20K to do the > > surgery which is not > > > very feasible at this point. I wish I had known > > this before we put > > the > > > braces on and started this process. I probably > > would have just opted > > > not to do it at all. > > > > > > Any ideas of ways to convince Cigna that this is > > not a cosmetic > > > procedure? > > > > > > > > > VERY frustrated at the moment > > > > > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
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