Cigna denying pre-approvals (Help)
Apologies if this is not the right place, but I’m new to this and need help understanding my options here.
Went and got an X-ray for some constant knee pain and my orthopedist referred me for an MRI on the area due to noticing significant subluxation of my patella. Cigna approved the X-ray, but denied the MRI for lack of medical necessity. Reasoning was that Evicore Healthcare’s guidelines said I needed a 6 week PT or NSAID plan before they would approve it. I could normally understand this as if it’s in their guidelines then it’s how they operate, fine. But when I looked at their guidelines, I saw that under dislocation/subluxation, that 6 week plan was deemed unnecessary and that an MRI was the next recommended step. I appealed this decision and received the same reasoning that I had not gone through the 6 week treatment plan so it was not medically necessary. I went ahead and paid for the MRI out of pocket just to move my treatment along as my pain was worsening, and my doctor recommended surgery after the MRI confirmed that my cartilage under the patella was beginning to wear down prematurely. Cigna has now denied the surgery after it being submitted only 3 days prior for reasons of no imaging showing weakened tissues or cartilage tears, and also no X-ray showing the kneecap is out of place or a defect in the knee. I’m at my wits end when dealing with them as every time I call I get passed from person to person who claim they are not authorized to deal with what I’m asking about, and I am so new to insurance in general that I don’t understand my options. Sorry for the long post, but I’m sick to my stomach with worry because I can’t afford the surgery on my own and it has become increasingly painful to walk. Is my only option continuing to argue with call center employees who just run me around?
submitted by /u/Beef_stuw
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