Question:
I have Cigna Pos insurance and recieved a denial letter today. 1the provider is not

contracted. 2the procedure requested does not meet the criteria for coverage of gastric bypass.3Phsycological exam. So can anyone help me here on what to do I am very upset about this and do plan on fighting. Just let me know thanks.    — Lynn D. (posted on March 4, 2003)

March 4, 2003
Hi, First, it appears that they require a psychological exam before they will approve. Second, there must be something missing from what you sent them that they require for approval (diet history, proof of morbid obesity for specified number of years, etc.) and Third, you must be using an "out of network" doctor/hospital. If your insurance doesn't require you to go to a network facility/physician but simply pays a reduced amount, that shouldn't be a problem. You need to check your policy and/or contact them and ask who they will cover. You also need to get their requirements for the surgery in writing from them so you know what you must supply them for approval. I would ask the surgeon for a referral for the psych exam. At least it sounds like they cover the surgery - there is not a written exclusion. It's just a matter of jumping through the hoops and meeting their requirements. Good Luck.
   — Carolyn M.

March 5, 2003
Hi there.. I too have POS Cigna Healthcare. You will have to pick a pcp if you don't have one... PCP = primary care physician ... go to cigna.com and search for one in your area if you don't have one already. If you do have a pcp then you need to get them on do a referral... Cigna won't let us do it..it has to come thru a doctor office. Next Cigna paid for my psych eval... just call the mental health on the back of the card and explain to them you need a psych eval for a WLS procedure that you are trying to get approved. If they say it has to be done...do it..it didn't cost me a cent other than distance to go to a doctor in network. Don't contact them till you get all your ducks in line... its like shooting a duck with blanks otherwise. You have to go thru some hoops to get approved... Those two are definately required as far as I know... good luck
   — WLS_Deb