Question:
2nd denial, Is there any legal action I can take?
I have high blood pressure,sleep apnea,diabetes, bmi is 46. The only thing they need to approve is documentation of weight loss attemt in last 6 months (med supervised). I have been fighting with them since Jan.2003. — Tammy T. (posted on October 8, 2003)
October 8, 2003
If I understand your post correctly, the insurance company is saying that
you must have a six month supervised diet, and they do not have paperwork
to document that you've done this. Then, if the documentation does exist,
get it to them. If it doesn't exist, then start a six month supervised
diet. If that's the only issue here, then I don't see that you have any
legal recourse. They can make whatever reasonable requirements they want
to, and nobody is going to tell them that you don't have to follow their
rules. The rule is a reasonable one, and if that's all they're asking, I
say do it, and stop delaying your approval by fighting it.
— Vespa R.
October 8, 2003
PLEASE!!! Let me intervene here. I went through the same thing with Kaiser.
I wasted 3 years of not wanting to do the stupid supervised diet. I could
have done the damn diet, gotten my surgery and been at goal all in the time
that I wasted fighting them. If you get a lawyer, it will cost you. There
is no way that you will be done with any appeals or legal action in only 6
months. Don't waste money and time. Do the diet, jump start your metabolism
and deal like the rest of us.
(Didn't mean to sound cruel, you just have the opportunity to not go
through what I went through - and I am kicking myself) -Erinn
— Erinn D.
October 8, 2003
The insurance companies don't seem to budge on the supervised diet. If you
haven't already asked your PCP to start documenting (all he has to do is
put in medical records that he put you on a low fat diet and have you come
in and get weighed monthly or at whatever interval your insurance
requires). Like the previous posters stated, in the amount of time you
spend fighting it, the money you'd pay in legal expenses (and still lose)
you could have the supervised diet over with.
Good Luck
— Carolyn M.
October 8, 2003
You should now have a recourse with an outside review agency. Check your
insurance and find out the what now? If you get an outside review your
chances are better. Check out my profile-you'll see what happened with me!
In the meantime-go get weighed in with your dr and start the supervised
diet. You just might get approved from the review as I did and not have to
do the six month but you're covered if you don't.
— toni S.
October 8, 2003
Tammy, I would have spent my energy doing the 6 month diet from January on
as you'd be done with that requirement and onto surgery. Start now and put
your energies where it will produce results. Fighting is not getting you
anywhere. Why is it a problem to comply with this if it is the ONLY way
they will approve you? With sleep apnea you need to do whatever they want
to get surgery. I was a 22/18 BiPAP before surgery and a 4 CPAP at 6
months out and released from any therapy at that point, so WLS truly can be
a miracle cure for sleep apnea. Stop fighting and give in and in early
2004 you will have your surgery. If you have Aetna, they will now allow
you to submit for approval before your 6 months is up, you just cannot
have surgery before the 6 months. At least that's what I've seen posted in
the past month or so.
— zoedogcbr
October 8, 2003
Cigna WILL NOT give an inch on the supervised diet rule. You can appeal
until the cows come home but it wont work. Like all the other said, stop
fighting and give them what they want. I was denied twice too before I saw
the light, gave in and did the diet. As soon as I finished that diet, I was
approved with no problem. Good luck to you. ~Sidney~ Open RNT 10-23-02
down 120+ and counting
— Siddy I.
October 9, 2003
Cigna will not waive the supervised dieting restriction, no matter what.
It's best to go to your doctor now, get started now and then re-submit
following documentation that this process has been completed. I did mine
in 2002 but then Cigna only required as 12-week program in the last year.
They changed their rule in November 2002.
— Cathy S.
October 9, 2003
The only way that you could have legal recourse is if you could prove that
they've approved someone else within your company with this same insurance
"plan" since implementing this particular rule. That would be
descrimination - maybe (there may be reasons for the approval of which you
are unaware). If they are treating everyone the same and the rule is not
considered barbaric (and while we may think this is, legally, it's not)
then you really have little choice but to jump thru the hoops the require.
Good luck!
— [Deactivated Member]
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