Revision Denied...Again

LadyLucky
on 2/24/13 7:18 am - KS
I'm curious what the vets here think of the new reason. I was sleeved 2 years ago, have gained nearly all the weight back that I lost. Now I'm looking to get the DS, have my sleeve redone (part of it stretched) and have a hiatal hernia fixed.

Here's the reason from Cigna:
The following will continue to be specifically excluded:
? Medical and surgical services to alter appearances or physical changes that are the result of any surgery performed for the management of obesity or clinically severe (morbid) obesity.
? Weight loss programs or treatments, whether prescribed or recommended by a physician or under medical supervision.

Okay, doesn't the first reason sound like they think this is for plastic surgery or something. I mean, the sleeve didn't cause anything that I'm trying to fix.

And the second one just makes no sense because bariatric surgery is covered.

Am I missing something? Of course, I have a call into my surgeon's office. But it took them forever (more than a month) to even get the paperwork submitted when it was all sitting right on their desk, even with me calling and emailing them twice a week. Anywho, is there anything I might be overlooking in this denial? And any suggestions from here? Obviously I'll appeal it again but I really just want my surgeon to call to clarify things. Maybe the codes were wrong? I can't figure this out. Ugh!
Valerie G.
on 2/24/13 8:07 am - Northwest Mountains, GA

I agree - it sounds like an exclusion for post wls plastics.  It's a stretch, but I guess they kinda-sorta can count that as a modification of a wls procedure, but it's a severe stretch.

Valerie
DS 2005

There is room on this earth for all of God's creatures..
next to the mashed potatoes

LadyLucky
on 2/24/13 8:29 am - KS
A gal I work with was denied for breast reduction. So along with her appeal, she included one of her size HH bras with the cups full of sand and sewn shut. She challenged them to wear it for a week. Her appeal was approved. I'm thinking I need to get my hands on a fat suit.
Valerie G.
on 2/24/13 8:34 am - Northwest Mountains, GA

OMG I love it!

Valerie
DS 2005

There is room on this earth for all of God's creatures..
next to the mashed potatoes

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