Has anyone had to dispute with an insurance?

[Amber Like Woah]

So my partner and I are both going through the process to get the insurance approval. I have called everyday to check on it, which I am pretty sure is super annoying for them and probably slows down things, but I am so stressed about it I cant help myself....

Well I called this morning and I found out my partners was declined. I know we have already filled out the paperwork for our doctor to be able to dispute it for us... Has anyone else had this issue? We have Cigna insurance....

I am like freaking out... I feel like with out this surgery I will forever be fat... I will never get to achieve the things I want.... I am sorry to sound like such a baby and complain, but I have really REALLY been trying to keep my feelings in check considering I have natural anxiety all the time.... This is so hard this hurry up and wait process. I have been told that it can take 4-6 weeks for approval and the whole process, and today it has been 5 business days... I am kind of freaking a little... any support, words of wisdom, experiences with Cigna or any insurance... please let me know!

[Daniella323]

Take a deep breath and relax! Insurance companies are usually a pain I'm the butt and seem to enjoy giving people a hard time. I'm not sure if your doctors office handles all your insurance issues for you, but if so, they will appeal the decision and get you approved.

[adoremi]

Did they tell you why your partners' surgery was denied ? I had a similar issue as well. My partner & I both decided to have the surgery, mine was approved and hers was denied. I work for an insurance company so naturally I called to find out why. You may need to call to speak with the nurse case manager who is handling her case but you will only be able to do this if there is a release of information on file. Once I was able to find out why her surgery was denied, I requested the surgeon request a peer to peer review in which they are able to speak with the medical director who made the decision. Ultimately her surgery was approved and she's scheduled for the 26th of September. Mine was on August 13. Good luck to you ! If you need any help or have any questions feel free to ask me. Insurance companies are not as scary as they appear.

[Christie Bun]

Aetna insurance denied me on August 19th the day before my scheduled date (August 20th) for surgery I was so depressed, my surgeon called me personally which is a WOW because I usually only speak with his assistant but he told me Aetna denied me because I didn't have 2 years of weight listed on my PCP letter although I have seen a NUT and Physiatrist (90days each),physiatrist , pulmonologist, cardiologist and had an endoscopy procedure and spent above a $1,000.00 is co-pays and will have to pay another $1,000 for the procedure ($ 500 co- pay and $500 deductible), AETNA sucks but I submitted my updated letter and started my appeal process on Tuesday so now I am just waiting to see what else they come up with..SMH but it aint over till the fat lady sings.

[PipperMarrow]

There is website on line that will tell you step by step what to do. He is a guy who fought with insurance for years and is a lawyer. I don't have the website saved on this computer, but if you google help with insurance denials on wls surgery it will probably pop up.

[Amber Like Woah]

Thanks so much to both you for the response. I called my Drs office and she received a fax saying that there was not proper documentation for our three months of non-surgical, medically supervised weight loss (which we did, and the drs office has confirmation they received). My Drs office is handling all paperwork and dealing with insurance I just call to check on it. She called them and resubmitted the paper work for a second review since it was properly submitted the first time, just over looked. I guess the fact that it is an error as opposed to a flat out denial is good. I just wish insurance companies were not such a pain to deal with, or that we did not get a different answer every time we call.

[Lucy61]

Let them work thru it - you can't speed it up and as soon as your doctors office gets the approval they'll let you know. If the insurance says they cover the surgery, it will be a matter of making sure all the t's are crossed and the i's are dotted. I know how hard it is to wait this last little bit after all you have both been thru, but just take a deep breath and know that you'll be scheduling surgery soon.

So that said - I recommend that anybody who is looking into this surgery, call the insurance yourself, get the part of your plan in writing that says they will cover it and the requirements to have it done. Once you meet those requirements, then it is a matter of submitting and approval.

[Marvinator]

I was declined twice before I finally got approval. Just address the reasons for approval and send it back. Eventually one would think they would have to approve it.