FrankTalk.org

So, Aetna, ultimately denied my implant procedure due to a wrong diagnosis code. That straight out screamed that they were looking at any way no to pay. My doc Dr. ( Le Roy Jones) was as confused as I was on their logic.

Now I am back to square one with insurance since my employer switched to Cigna.

Has anyone else dealt with that non-sense as well?

Not a denial but my insurance was definitely trying to talk me out of it. UHC rep called me after surgeon's billing dept. submitted the claim. She went into all the negative details that could possibly happen during the surgery.
Keep submitting a claim. Keep fighting the insurance. ED is a broken body function that needs to be fixed.

Be careful i had Cigna with my first one they okayed it... conformation # whole bit then 3 days before surgery on a Friday got a letter said its not covered Talked with Doc and Hospital said they cant do that .... went a head had surgery got stuck with a 89k dollar bill from the hospital i paid for Doc and anesthesia out of pocket which covered the deductible.... all i can say is be carful with Cigna
Jim

rdnkbiker wrote:Be careful i had Cigna with my first one they okayed it... conformation # whole bit then 3 days before surgery on a Friday got a letter said its not covered Talked with Doc and Hospital said they cant do that .... went a head had surgery got stuck with a 89k dollar bill from the hospital i paid for Doc and anesthesia out of pocket which covered the deductible.... all i can say is be carful with Cigna
Jim

Thanks for the heads up. If they decided to try and pull that I would have no trouble taking them to court over it. I will make sure I have that in writing if approved.

jdsatx1977 wrote:

rdnkbiker wrote:Be careful i had Cigna with my first one they okayed it... conformation # whole bit then 3 days before surgery on a Friday got a letter said its not covered Talked with Doc and Hospital said they cant do that .... went a head had surgery got stuck with a 89k dollar bill from the hospital i paid for Doc and anesthesia out of pocket which covered the deductible.... all i can say is be carful with Cigna
Jim

Thanks for the heads up. If they decided to try and pull that I would have no trouble taking them to court over it. I will make sure I have that in writing if approved.

Surgery done Nov 16, 2022. Awaiting word on my 2nd appeal with BCBS. They authorized the surgery to deciding to not pay afterwards, The Board met early December and still haven't heard a word. Everyone seems to think that they will eventually pay and my good Dr has not asked me for a dime...yet. Just incredible. Lawyer waiting on the sidelines too.