Question:
Help! I'm in 2nd level appeal w/Cigna & have a telephone conference call w/Committee
Hi...I have been denied by Cigna several times within the past 2 years. The first time was no co-morbidities...since then I have been diagnosed with Sleep Apnea, Arthritis (knees), and Acid Reflux so I applied again...and was denied for weight loss history. My surgeon's office says they sent everything that Cigna has been asking for and they can't see them coming back with a denial again. This is my 2nd level appeal and they said I can be included in the conference call with the Appeals Committee. My question is...what kind of info should I have prepared? What are they going to ask/talk about? I just want to be sure that I have all the info that I am going to need...but I'm not sure exactly what that is. Any help is GREATLY appreciated. Thanks!! — Giovanna G. (posted on August 5, 2004)
August 5, 2004
Do you have a 26-week physician supervised diet history that has occurred
in the past year? and one further back? Cigna will probably deny you if
you haven't documented that. Be sure to prepare some statements of how
your weight is affecting your "quality of life" and "quality
of work". That will help too. Stay really positive, but firm with
them. Cigna is a bear.
— Cathy S.
August 6, 2004
I am also dealing with Cigna. I have to finish my psych eval and nutrition
eval before sumitting for denial... I mean approval, but am prepared for a
fight! I have found alot of great information from
http://health.groups.yahoo.com/group/Cignassqueakywheels/. I would
reccomend checking that group out, they can also give names of people to
help with the appeals.
— Carmen S.
August 7, 2004
Make sure you talk about "medical necessity" reasons and use that
term. Talk about your health issues mainly and if you have parents or
siblings that have major heart or other diseases that you would be trying
to prevent in the future.
You can talk about knee replacements, physical therapy, GERD meds
etc..(which are expensive) talking $$ to them is good.
— ZZ S.
August 8, 2004
Read your post re: committee conference call. If at all possible, GO TO
the meeting IN PERSON. They need to SEE that you are a PERSON, not a sheet
of paper. Trust me on this, I used to work for an HMO and participated on
grievance committes. The participants are more likely to say yes when they
are looking at you sitting a few feet away from them. If not, be sure to
tell them that YOUR LIFE DEPENDS on THEIR DECISION, and you need them to
approve the procedure ASAP.
Good luck,
Diane N
www.WeightlossSurgery.ws
— DianeN
August 14, 2004
Hi Everyone...Just wanted to give an update. On August 5th, I called Cigna
to tell them I would be on the call. (The option of going in person wasn't
given to me, plus it is in North Carolina so I probably wouldn't have been
able to go anyway).
They told me the call was cancelled because the appeal should have been
sent to Intracorp, instead of Cigna directly. Funny how they realized this
about 3 hours AFTER I called to tell them I would be on the call. They
received the appeal on July 19th...and didn't realize it until the 5th of
August that it should not have gone directly to them???? Don't understand
that. So the wait continues..........
— Giovanna G.
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