Question:
I PLAN TO FIGHT MY DENIAL, BUT WANT INPUT ON OTHER INSURANCE
I got word that Cigna HMO denied me...I'm not fat enough for long enough...and my co-morbids are not "bad" enough. Of course, I plan to fight it, but I would like to know about insurance out there that will approve easier. My doc that I had most of my life has disposed of my records (only keeps them five years) and I am having a hard time proving my prior diets and weights. Will Cigna PPO or POS approve by different criteria, Aetna PPO is another that I could change to. I want to know which insurance companies will approve "lightweights" — Laurie V. (posted on May 10, 2002)
May 10, 2002
I have CIGNA PPO, and did not have a hard time at all getting approved. I
was 289 pounds, and now weigh 172 as of today at the doctors office. I
think you may have a better chance with the PPO Plan. You do not have to
have your Primary Doctor info, They can use your surgeons letter to
approve you. Hope this helps.
— Valerie M.
May 10, 2002
I really don't have any advice, but I wanted to wish you luck on your
journey. I would not let the appeal process scare you. Good Luck and God
Bless!
— Beffy W.
May 10, 2002
I am 238 pounds and my insurance (United Healthcare, PPO) did not hesitate
in my approval process. My doctor's office did all the work for me and I
was approved with only a letter from my doctor. I am really healthly, but
I too have a family history of problems. I know this surgery will help me
to prevent those same problems as I get older. Maybe you should try Aetna
PPO. I know they have approved many patients on the first try. I used
surgicalweightloss.com and the Images team did it all for me. Good Luck.
I know it will work out for you in the long run. Hang in there!!
— Cindy M.
May 10, 2002
I have Humana Choice Care and they almost seemed too easy for my approval,
I didn't need a PCP referral, just a dictated letter from the surgeon and
it helped to have my own letter written up to the insurance. I weigh 262
and 5'8 and only 20yrs old... and they approved me... with no comorbid's or
anything.
— Sunny4x4chick
May 10, 2002
Laurie, I just called my ins. co.(Cigna PPO) yesterday to ask them if they
covered gastric bypass surgery. To my amazement they said you have to have
a pre-determination letter of medical necessity and office notes. She said
nothing about diet history or anything. I haven't gotten as far as
submitting to in. co. yet so I can't help you there. Good Luck!
— angela D.
May 10, 2002
Are all these choices being offered to you by your employer? If so, there
may not be any differences in coverage between a PPO and an HMO from the
same coverage. I had that choice once and the coverage was the same. The
difference was that I had to pay more for the PPO coverage and had
deductibles to meet. However, I also could go out of network and still get
coverage. The problem in answering your question is that policies can vary
widely from one employer to another, from one state to another and so on.
— garw
May 10, 2002
— Lynette D.
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