Question:
Has anyone with Cigna PPO been approved lately?
I have Cigna PPO in Ohio and I am in the process of my first appeal. I was wondering if anyone got approved after their first appeal or were denied again and had to file a second level appeal? Thanks!!! — Audrey W. (posted on May 17, 2003)
May 17, 2003
I have cigna hmo in california and i was never denied or had to go thru
appeals. You really need to have medically supervised diet it one of there
bigest ways of geting approved right away. Plus i had a hital hernia that
needed to be repaired. But i joined weight watchers as soon as I statred
hearing about the horror stories of people geting denied because of no
medical supervised diets. Plus i called my old hospital (kasier) I had them
copy all of my old medical records from the past 10 years and sent that in
along with a letter from my PCP and one from my personal trainer friend
from the fitnesss center i go to. Also i sent the insurance company a 12
page personal history, family history and diet history and all the medical
history I could get a hold of. You really have to go over the top and be
persistant. Fax all that stuff in sevral times and keep copy's of
everything for your personal records.
— sheri B.
May 17, 2003
I have had (3) dr. supervised diets within the last 6 years all over 26
weeks the last one within the past year. I have GERD,acute
asthma,fibromyalgia, and irregular periods all from being obese, all
documented for the last 8 years in my medical records. I had a letter from
not only my surgeon but (2) PCP's the one I've seen for 5 years and the one
I saw before him that stated in their professional opinion I am a perfect
candidate for this surgery. My BMI has been over 40 for 2 years and had
been over 35 for 7 years. I too wrote a 5 page letter explaining what it
was like to live as a morbidly obese person day in and day out. I even gave
them a copies of every test I have had done within the last 2 years for my
comorbities that totaled $15,000. I was still denied even with all that. I
guess I just can't believe I was with my record and history. I think Cigna
PPO in Ohio is very hard to get approved with. I hope nobody else has to
jump thru all the hoops that I have done. It just really steams my clams
when someone really does qualify for WLS and they just don't want to front
the money.
— Audrey W.
May 17, 2003
I have Cigna PPO in WA state. I had no problem at all. Gave them all my
diet attempts, and within 2 wks I was approved.
— TLLessor
May 17, 2003
I, too, have Cigna PPO in Houston, TX. I have a BMI of 45.7, 269# on a
5'4" frame. I provided all my diet history (everything known to man),
clearance letters from my PCP, all blood tests, psych eval, ultra sounds
and I was denied. Now they want nutritional evaluation, internist clearance
- I've supplied that plus a chiropractor's evaluation. Cigna is known to
turn down on the first try so I was prepared for it. NeWeigh has their own
Patient Advocate Group that fights for our rights with the insurance
companies, thank goodness. Patience has never been one of my better
virtues! I just found out yesterday it may be another 6 weeks before I hear
of my appeal. I'm going to take this time to get stronger before surgery. I
work out at Curves 4-5 times a week and powerwalk every other day. The
stronger I go into surgery the better I will be. Hope this helps - good
luck to you!
— Sunie I.
May 18, 2003
I appreciate all your answers so much!!! Insurance just gets so
frustrating!! It's great to be able to come here and get a personal answer
from so many wise people.Thanks everyone!!!
— Audrey W.
May 19, 2003
Hi! I have Cigna PPO in Illinois. The only problem I had with them was
they kept saying they didn't receive my paperwork and then when they did,
they didn't understand the code for Lap RNY. All I had to do was send a
letter explaining that Lap was the same as open, but without the opening...
lol. That may not be how I worded it, but it was the general message.
Anyway, the most important thing I found was that they never communicated
anything to me and the only way I found anything out was because I kept
calling them. I was fortunate enough to get an "angel" at Cigna
who took my case under their wing and helped to see it through to the end.
I was approved in about a month and a half. Hang in there... with a little
tenacity, you'll be fine. Good luck!
— [Deactivated Member]
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