Question:
Has anyone been up against Cigna HMO in Texas for 2nd level appeal?

Surgeon and family physician both are recommending surgery, but Cigna has denied twice (original request and first level appeal), because I don't have past history (last 12 months) of non-invasive methods (weight watchers, etc.) They admit I'm morbidly obese, but hanging everything on the lack of records. Have a face-to-face with panel of doctors 8/7/02 and could use some help or advice.    — Kathy W. (posted on August 3, 2002)

August 4, 2002
I had the same problem here in VA with Cigna. Go to your primary care physician and tell her you need a 12-week physician supervised diet. During that time, you'll need at least monthly weight-ins. Also ask that during that time can her notes document all your co-morbidities in some way, shape or form. Then when the 12 weeks are up, get copies of her notes and re-submit. That's what I did and it worked on a Level 1 appeal.
   — Cathy S.