I think my surgeon's office lied to me

 So i told everyone on OH a few weeks ago that my Dr told me i was approved for surgery. SO WRONG! i got 2 letters in the mail last week saying i was denied for the lap band(which was a mistake) and denied for the VSG. i was so devastated. i cried and cried and cried all day. Why would the dr tell me i was approved before he had any proof? i had my hopes up so high that i would be sleeved in the next few weeks just to have them crash and burn.  I called cigna myself to find out exactly why i was denied, the lady on the phone told me the dr just needed to submit more paper work giving more info on why the surgery is medically necessary.  Well i called the insurance coordinator at the surgeons office and attemped to tell her what i found out. She said that wasnt the reason. Apparently they told her the nurse at cigna did not research my policy enough to find that i was actually covered for the surgery.. i dont know what to believe anymore. I know its in my policy. so im hoping this is just one big misunderstanding.  i just wish they wouldn't of told me i was approved before actually knowing i was approved.  The surgeons office is suppose to be submitting the appeal, but should i get involved in this. What have others done? should i send them all my medical records that go along with my obesity?

 Fingers crossed that it was just a misunderstanding. I have Cigna also, and it was a PAIN to get my approval. They said paperwork was missing when it wasn't... They just want reasons to say NO. 

I would call your Dr's office and have them re-submit anything that Cigna said was missing. Once my Dr's office did that, I had an approval the next day, and my surgery was 4 days later! :) 

Good luck!!!

 WOW that's fast! 

I'd call and talk to CIgna and to your Dr. I'd call and call and call! good luck!

Every time i called Cigna and would get a different person I would get a different answer. Bug the surgeon's office like I did. I called twice a wee****il I got an answer.

I think you'll be approved - it just sounds like mis-communication, it happens.  But definitely get on your insurance coordinator at your surgeon's office.  I despised the woman who did mine, who dropped the ball on me so many times that I finally raised a ruckus and the manager took over.  The rest of my approval went swiftly and smoothly.

Don't cry!  OK, cry a little, but get pro-active.  You can do this and you WILL get your surgery!

 Not to seem flippant- but dealing with insurance is like this every day of the year.  And even after they approve you and you have the surgery- stay on top of it becuase they can go back and refuse to pay.

So call, call, and call and more importantly get it all in writing so you will be covered if they try some backhanded trick later on.

JB

There was another post on here a couple weeks ago about issues with your surgeon's insurance/office staff and I think it's a similar situation.

Personally, if a staff can not be efficient, don't let the surgeon cut on you. You could get a crazy bill for charges that are not contracted under your plan.

I'm not saying change surgeons, but this type of situation leads to more heartbreak months out when the hospital bill starts rolling in for your portion. You need to get your hands on a copy of your exact, full policy, exclusions, explanation of benefits, percentages of out of pocket expenses and outline of coverage. I'm an insurance agent, and if this is an employer provided policy, go to HR, or your employer insurance coordinator, and have them review it with you to ensure you understand the plan fully. Just because Cigna covers the VSG doesn't mean your employer provider plan offers bariatric coverage. More and more employers are cutting those services to bring down cost on their insurance premium.

It sounds like a miscommunication. If this was my situation, i would have the Dr office resubmit and I would ask for a copy of my medical records. This will be helpful for you to see what was submitted to the Insurance co. If you feel there is information missing, I would also request information from a PCP or any other Dr that can speak in ref to your health. And submit that information to the Ins Co. as well.

Good luck.

I think I'd get the insurance company and insurance coordinator from the Dr's office on a 3-way call - and do not hang up until everyone knows what THEY need to do. Insurance really is NOT rocket science. Either it's covered or it isn't, and the requirements are what they are. Sounds like you just need to eliminate everyone pointing their finger at the other person.