If Cigna Denies, Will Tricare Approve???

I have Cigna Open Access as primary insurance and Tricare Prime as secondary. Does anyone know if Tricare will automatically approve me if Cigna denies me.

My surgeon has submitted everything to Cigna (6 month diet, psych eval, nutrition consult, etc.). Tricare only requires 200% over ideal body weight - which I am.

It would have been so easy if I didn't have Cigna. I'm wondering if I'll have to start all over again if Cigna denies me (e.g. referral from PCM).

Any help or advice would truly be appreciated.

Thanks,
ML

If Cigna denies, I think I would try Tricare before starting again. I am not sure how it works with Tricare as a secondary, will you need a new referral through them? If so, does your current surgeon accept Tricare?
If he does, I think I would ask my PCM for a referral by name to go to this surgeon, then you wouldn't have to start over for anything. When your referral is approved, they can submit immediately for surgery approval.

Thanks so much for your reply. My current surgeon does accept Tricare so I'm hoping that all I'll need to do is have him submit the denial info to Tricare in order for them to approve.

I'm so anxious to move this forward. These boards have been a god send.

Hi ML,

I have Cigna HMO (does not cover out of service) and they did approve me after doing the six month weight loss program, psych evaluation and group sessions. I had a BMI of 56 when I had my surgery. So its probably just a matter of time. Hope you hear from them soon.

Thanks. It is incredible how difficult it is to work with the insurance companies and how different they all are. I can't wait to be able to post that I'm approved and ultimately banded like you! :)

Why on earth did he not process both insurances when he submitted to cigna?? When I worked in a dr office (was just a part time/temp secretary) we would submit to multiple insurances if the patient had more then one. I don't think things have changed that much in the 5years since I did that, but you should ask him why they didn't submit both.

BUT, tricare should not deny you and they should go off of the 6month previous diets and stuff. Besides what cigna wont/can't cover tricare will probably pick up. Have your doctor submit to tri-care what cigna wont cover along with your 6month diet etc. I am tri-care but I did my surgery at the Army hospital so I didn't have the same insurance hoops as most, I had military hoops to jump *sigh* but that I did, that I did.

Pix, Great question about why they didn't submit to both. I suspect it must have something to do about the negotiated rates for the surgeon; Cigna may pay more than Tricare? I will certainly ask about this once I get some word on my approval from Cigna.

I have Tricare Prime, but I'm a little concerned that they may not approve my referral to the surgeon I've selected since they perform lap band surgery on base (not too far from me). I'm just very familiar with the surgeon I've selected and love the hospital he's affiliated. So this may be another hurdle to overcome if I get denied.