Question:
Is there any hope? My appeal was denied.

Is there any hope? My appeal was denied. Cigna said "doctor did not prove medical necessity". My BMI is over 40. I don't get it. I've already had all my pre-op tests and my surgery was supposed to be tomorrow.    — Roberta M. (posted on May 24, 2004)

May 24, 2004
I am so sorry that you are experiencing this frustration. I'm not sure you can turn things around by tomorrow but there's no harm in trying. If you have a surgeon's office staff that will work with you they can fax over information and speak with their contacts there. In addition you can also fax over all of your information. You might also advise them you are seeking legal counsel. It is important to be firm but to also be nice. No one wants to go out of their way to help a meany. Do you have a PCP, Endocrinologist or other medical professional who would dash off a faxed letter for you? If you can get a sympathetic customer service rep on the phone they might see if they can push things through if they know your surgery is scheduled for tomorrow. If not, don't give up hope. Exclusions can be air tight. You are dealing with something you can work with. My thoughts and prayers are with you. Hang in there as best you can, ok?
   — ronascott

May 24, 2004
I'm sorry you're having such a rough time right now. Just wanted to say you definately still have hope. My appeals were denied 4 times, I hired attorneys & had an an administrative review. I also drug in the Pres. & VP. of the co. I work for. It took me right at a year but I did it. You definately have hope! If there is anything I can help with...Please - send an e-mail! Kathleen
   — Kathleen R.

May 24, 2004
I am also sorry that you are having such problems with your insurance company. I don't know if you have the same options in California as we have here in NY, but I am now waiting for the result of an external appeal. I had to request this of the NYState Insurance Board who sends the information to an outside review company with professionals (in my case plastic surgeons) who review the supprtive documentation I provided. My denial reasons are explained in my profile. I should hear in approximately a week. I would start gathering any information from your doctors regarding any weight related health difficulties. I had letters from my WLS surgeon, primary Dr., dermatologist and PS. I also sent along pictures of the nasty rash under my belly. I would as I mentioned, try to gather as much supportive info as you can think of and contact your state insurance board. Good luck!!!
   — Fixnmyself

May 26, 2004
Robera, There is always the option of self-paying. I went to Spain for my surgery with Dr. Aniceto Baltasar. He's one of the world's leading bariatric surgeons. Not only do you get an awesome surgeon (who is a friend for life - he's such a sweetheart!), but it's also VERY affordable. Everything - travel, surgery, everything - for me was $15,800. Let me know if I can answer any questions, okay? Blessings, dina
   — Dina McBride

Click Here to Return