Has Anyone Had Any Experience with Cigna Insurance?

  • Nessa2
  • North Carolina
  • 1 year ago

I called my insurance to see the the qualifications are for a breast redution. All they tell me is that it has to be  deemed medically necessary. It's like the try to beat around the bush. As matter of fact, they said that a breast redution was not covered but an reduction mammoplasty is.....isn't that the same thing? As anyone had any experience with filing Cigna when getting a breast reduction...or reduction mammoplasty?

Comments (5)

When I called Cigna and I asked the same question, they gave me the same answer. So I when on to Google and typed in "breast reductions requirements cigna". The second or third line item told me EXACTLY what I needed to do in order for them to cover my surgery. 1. Make sure your qualify for the surgery, physically; large, heavy breasts. Pictures as proof. 2. Grooves in your shoulders from the bra straps. Pictures as proof. 3. If you have any rashes underneath your breast, have your PS take photos of those too. 4. Three month continuous trial of "proper medical treatment". An (*) will later explain that this means you need to go to a physical therapist for 3 months (I had my gyno write the Rx). It's a pain- I went once a week for exactly 3 months. But it will be the cherry on your "gimme my breast reduction" cake. 5. Go to an orthopedic doctor. Get an xray of your spine and have him/her write a note stating there is nothing wrong with your spine. 6. This is just extra- have your gyno write a letter documenting back pain. It may seem like a lot. It may seem like it's going to take up too much of your time. I did ALL this before my PS sent in my case. I was approved by Cigna in 2 weeks and 3 days.
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Five years ago we had Cigna. After my last child I decided to inquire about a br after constantly being told by my OB/Gyn that I needed one. Finally made the appt to see if I qualified for the surgery. Once I arrived and told the nurse I had Cigna, she informed me that she had been doing her job for the past 18 years and in that time she has had ONE patient approved by Cigna. I was quite heart broken to hear this. I went ahead with the exam to see if I qualified for the surgery and I did. I have switched insurance, now have Tricare, and was approved within two weeks. Hated hearing that Cigna was not a good insurance carrier for BR surgery.
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Yes, I have Cigna...I just had my br on jan 16th... I went to see my ps in August and he put together my case and sent it off, about 3-4 weeks later I got a letter saying denied as not a medical necessity, so my ps appealed it and sent off more stuff including me getting a back X-ray to prove that I didn't have an underlying back problem that was causing my symptoms then a about 2-3 weeks after that I got a letter saying it had been reviewed again and I was fully covered..whoop..so don't give up, I think it is standard for some insurance companies to say no the first time round....good luck I hope it all works out for you !! Only 9 days post op and feeling very happy with the results!..so go for it, don't give up!
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did they pay for all the costs or did you have to pay a portion? i am going to make a medical case but i just wanted some more information and advice maybe?
did they cover all costs or did you have to pay a portion ? i am building my case bc my back doctor confirmed my back pain is from the weight of my breasts and i have xrays, just not the 3 month phys therapy i only went for a few weeks. did you get approved with only the ps appeal or did you too do doctor appts and therapy?