As you may recall, my case was presented to CIGNA by my surgeon's office on August 7th for approval. CIGNA had 30 days from the 7th of August to make a determination. Once approval for surgery is obtained, it can take up to 2 weeks to get "in" for the gastric bypass procedure.
That said, I've been very hesitant to commit to much in September. I was SURE I'd gain approval and go under the knife by the first or second week of the month.
NOT SO MUCH. Today I got a call from My New Self saying that the paperwork came back from CIGNA and it was a denial! For some reason that option never really occurred to me. Needless to say, I'm quite devastated and on the verge of tears as I write.
Jennifer (my insurance coordinator) at MNS did tell me that she thought they were wrong and why. So she submitted it back to CIGNA for re-review. Apparently they ruled it an out of compliance issue, as if I had not been compliant with the band. But she went back and explained and showed them the documentation where the band had failed me, where my body had rejected it by vomiting for 3 years. They also said they needed a referral from my primary care doctor. I don't get all this insurance crap, nor do I want to. But she went on to explain that they are a "Center of Excellence" and do not need that and also some other things she disputed with them. So we'll see.
For now, all I know is I still don't know whether or not I'll get to have the surgery or when........so I continue to be non committal. That's not good, First, my boss wants me to start traveling more. So I can't just books stuff then have to cancel all those trips. Secondly, I really wanted to volunteer for some of the benefits that are being hosted for a friend. They are all coming up the first week or so in September.
What Jennifer did explain is that this isn't the end of the road. The "war" is not over. We just lost the first battle. Next step is to wait for CIGNA's "re-review" determination. Then IF they deny it all over again, she will have the surgeon do a "peer to peer" with the medical director at CIGNA. I'm praying she can beat them into submission!!!
Right now I feel like I've been sucker punched; and I'm bummed. I'm so worn and ragged from all the other battles I deal with on the daily (trying to fight with the bank and short sell my KS home, dealing with complete and utter chaos in the work environment, trying to get a child in to see an Autism specialist, etc) that I don't know how much fight is left in the dog!
Fortunately, for me, I don't have to do head to head battle, Jennifer is representing me. My job is to kick back and wait.
That's just it. For a control freak like me, the waiting is always the hardest part.
I'm afraid to ask for your prayers given all those I've requested lately for my aunt and my friend. So how 'bout sending some good "juje" instead?
I'll keep you posted when I hear more...............Have a great week.
Lori
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