Cigna Refused Insurance, Need Lawyer

I have Cigna insurance and they have refused to pay for Lap Band surgery. Not just mine but they say they will not pay for anyone. How do I make them see that I need this surgery. My Doctor has refered me to a Lap Band Surgeon and I have my first visit on July 17, I have to pay 400 dollars up front. But then I still can't get insurance for the rest. I need a lawyer in my area that could help me force them to approve the surgery. Any one had this problem please let me know.

I have cinga and thay approved me maybe your employer will not pay for the surgery.

I'm not sure what their policy manual states, but if it is not listed as a covered procedure, they have every right to deny it. Unfortunately...

Thanks for the quick answers, I do understand that they can refuse it, but I have heard of some people getting a lawyer to help them. I am not sure at what point to get the lawyer involved and which lawyer to contact.

Check with your HR dept. If your company excluded WL surgery then blame them, not Cigna.

I have Cigna, Open Access through the state of Tennessee and they paid for my surgery. I paid my surgeon $50.00 and the hospital $80.00. That is it!

Cigna also has a nurse that has called me twice to check on how I was and give me support!

I was also approved in 72 hours.

It probably is a company exclusion. I have United Healthcare and I read on here all the time how they paid for folks surgery. However, they wouldn't pay a dime for mine, and it's because my husbands company put an exclusion on any bariatric surgery. When that's the case there's not much you can do, maybe appeal through your HR dept. By the time you paid legal fees, it would probably cover the surgery. However there is a website I see mentioned a lot on here but don't know the exact address, if you search around you'll probably find it. Something like obesity law or like that.

Hi Cathychatts, I was so encouraged to read your post. I too, have Cigna Open Access and am awaiting approval from Cigna. I call the automated system at least twice a day to check my authorization. I get transferred to customer service, who tell me that it is "pending review." You were approved so quickly; I'm thinking that it may not be looking so good for me since its now been almost 7 days.

I have found that a lot of employers are able to offer cheaper benefits to employees but to do so they are signing a wavier that eleminates ALL weight loss procedures of any kind. You might ask your company if they signed that wavier. I took a job at a practiculair company because I wanted their benifits to get the surgery just to find out they had signed this wavier and there was no way I could get anything done about weightloss no matter how life threatening it might be. Now I asked about that before taking a new job and different insurance coverage. Hope this helps.

Becky

I have Aetna and my husband's employer also excluded WLS which is why the cost of the coverage is pretty reasonable. If the employer chose the exclusion, there is nothing you can say or do to force them to cover you no matter how badly you need the surgery. As my surgeon's nurse explained it to me, it's like if you have a flood, if you don't have flood insurance, it's not going to be covered. The only advantage to not having it covered is that you don't have to jump through all the hoops the companies make you do. I was able to schedule mine in a few weeks. I took a loan from my 401K plan and am now paying myself back, so it's all good and was worth it!