Saturday, November 8, 2008

The Insurance Approval Process

I went to a seminar at Durham Regional on January 11th. I got all my applications materials into Duke in mid February and my first appointment was May 21st. I went to my first apointment with Duke, I had my psych eval and meeting with the RN. The nutritionist was out that day so he reviewed my records and sent me something later. I continued going to my Primary Doctor once a month every month. We did a low fat/low calorie diet with increased exercise and I tried Meridia for three months, but stopped because it was causing anxiety. I requested and received five years of medical records documenting a BMI over 40 (though I don't believe this is a Cigna requirement). I had an EKG, a Barium Swallow and blood tests. The tests were not that bad but I threw up twice during the barium swallow, it tasted awful.

All of my tests were normal and I have no co-morbid conditions, but my current BMI is 54.I sent all my medical records to Duke on August 11th. I was submitted to insurance on September 17th. UHC gave me a problem and would not give me a letter in writing stating that WLS was an exclusion on their policy. (They also told me they did not have a fax machine). They said the only thing in writing they would give me would be a denial EOB after I had the surgery and submitted it to insurance. They have still refused to send something in writing, but we submitted to Cigna with a copy of the plan documents.It was submitted to Cigna on 9/22. They initially decided to deny it on 9/25 stating that I did not have a nutritional eval. Duke forgot to send it with the intial eval, I called Debra and she faxed it right over. I called Cigna again and they said to expect a decision next week. Debra from Duke called me at 4:15 on 9/25 (today) and told me that Cigna had called and approved it. I called Cigna to confirm because it seemed too good to be true. I had heard horrible things on here about Cigna and was really worried about insurance approval, I must say the process was very easy and everyone I talked to at Cigna was very helpful. I have heard things about Duke being very slow and it did take a while to get my first appointment. However, from the time they got my medical records until the time I was submitted to insurance was only a little over a month. Everyone I have talked to over there has been very polite and helpful. My approval from Cigna may have come faster because I called a lot. I was always polite with them though. Anyway, that's my story. I hope it helps someone who is reading all the bad stuff on here about Cigna.

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