Question:
What is the best way to appeal with Cigna HMO?
I have provided Cigna with everything they required and they still denied me. Stated I did not prove I had been overweight for the last 2 years. I had my info from when I joined WW on 5-1-01. Have any of you heard of a "peer to peer revue"? — Karen T. (posted on July 9, 2003)
July 9, 2003
I'm not sure how to appeal... what grounds did they deny your surgery? A
peer review is simply a bunch of "medical professionals" (usually
a couple of nurses) getting together, looking at your records and deciding
if you are sick enough to warrent surgery, as if they have ever seen you or
treated you. That's basically it. It's wrong because they are not the
doctors treating you and have never examined you but insurance companies
routinely use this tactic to justify denying expensive procedures.
— Happy I.
July 9, 2003
Peer to Peer review is just that the doctor who reviews your case should be
a bariatric surgeon, or whoever is doing your surgery the reviewing doc
should be the same. If you have the WW info since 01, I would call and talk
directly to them (the nurse who is handling your case) to ask if they
actualy recieved this info and was it sent to the advisor (doctor) that was
doing the review.
— ZZ S.
July 10, 2003
I was not sure how to handle an appeal to my insurance co. MMO Medical
Mutual of Ohio. At the information meeting I attended with Dr.Kligman in
Toledo, Ohio, he had told us not to use up all of your appeals before
considering a lawyer. He gave the name of Walter Lindstrom, Who is a
Obesity Law Lawyer in San Diego, Cal. His email is [email protected]
and the web site is www.Obesitylaw.com you can get all the information you
need and they will answer any questions. I started my search and decided
to hire Mr. Lindstrom and his wife the early part of January, by the end of
March my appeal had been over turned. I hope this will help I was at the
end of my ropes and this was an answer to my prayer's.. Good Luck Danise
— Danise G.
July 13, 2003
I asked my primary doctor for copies of a few pages from my chart that
included the date, weight, blood pressure, etc. I highlighted those things
and it was proof of being overweight for many years.
— Chris S.
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