"Denied, deal with it" - Anyone else???

doglover14

My surgeon called me last night to inform me that my insurance had denied coverage for using a "Spy Camera" during my mastectomy operation, scheduled for next week. The reason given was "it is not a necessity" for the operation. The Spy Camera, based on my surgeon's explantion, is used for timely detection of the dying skin from inside of the chest once the breast tissue is taken out; therefore that the surgeon could replace the dead skin (or the dying skin) with healthy skin taken from another part of the body during the same operation. He was so surprised that the request was being denied because he had never been denied it before in his medical career, by any insurance company. He tried to reason with the insurance company, Cigna, and he did speak with the medical director who is in charge of the approval process. The response my surgeon received from the medical director was "denied, deal with it". My surgeon is concerned because without the "Spy Camera", the possibility of not being able to capture all dying skin is greatly increased, and the result of it would be that the surgeon would have to re-open the chest to remove the dead skin and replace it by the healthy skin later on, which means another operation! If I follow the doctor's procedure without the insurance, the cost could be up to $10,000-$15,000. I tried to call Cigna yesterday, but got no where since it was New Year's Eve and no one was around. Has anyone had a similar problem? How did you handle it? I am thinking of filing an appeal with the insurance, also check into filing the external appeal with NYS Dept of Finance. Any other suggestions? Your input is greatly appreciated!!!!

chrissilini

So sorry you are dealing with this. It's bad enough to have cancer, but to deal with insurance company crap is icing on a really bad cake. I have Cigna as well and find them to be less than helpful. A week before my surgery, my plastic surgeon told me they envied my reconstruction. They said they needed more information. What? What more info do you need? I have cancer!!!! They did finally approve it but I was shocked, as well as my ps that they questioned the necessity. They did refuse to pay for my 3D tattoos from Vinnie. Myers though, after several appeals because it wasn't done in a medical facility. 

I don't know anything about the spy cam. But I would fight it. I know insurance companies are required by law to cover breast cancer surgeries including recon and tattooing. I believe the law has been in effect since 1998. Don't let them get away with it.

Good luck to you.