Denied again..... (after 1st appeal)

Well, I called CIGNA appeals today over my lunch break. They didn't call yesterday as the "number I gave them was in correct". (Umm..NO, you IDIOTS wrote it DOWN wrong. I sure as hell know my cell number!!) I'm denied once again, due to it "NOT being medically necessary". I didn't probe further. At that exact moment, it just didn't matter. I'll wait for the letter to come, that will hopefully explain in greater detail WHY. (They said they mailed it 6/13/03!!??) I didn't want to get pissed off or upset while @ my new job. It def. put a downer in my day. Don't get me wrong, I am SOO happy for all the folks that DO get approved, but where is the consistency? And why should it have to BE this damned hard?? I don't know where to turn now. I THOUGHT my appeal was well written, and that I had things so well documented. I don't know what more they want from me. Honestly, I don't know WHERE to turn now. I'm just so sad....

Okay, take a deep breath, now blow it out. When you get the letter of denial, you can start the new process of getting approved. I am thinking that if they said it was denied due to not being medically necessary, that says they do approve the WLS, it might just be a matter of the way your pcp or surgeon coded it or worded it, because this WLS is medically necessary. Let us know what happens.

Hi Michelle! I'm so disappointed for you. I'm right behind you with the same fears. Would you be so kind as to tell me specifically what they said you needed in your first denial letter and in your second one? It would be so helpful. Do you actually have documentation of 3 26-week requirements? I read on our obesity help board here that it was 3 12-week, one of which was in the last year. It's so confusing, because they won't tell you a damned thing! Love to you, angel! I know the next days are going to be tough! Breathe! Just Breathe! Don't take the tension out on your already suffering body. Patti in Tucson

The first time I was denied they said it was due to the fact that I hadn't tried enough "less evasive" weight loss programs. Actually, I have had plenty, such as , Weigh****chers, Trim 4 Life, (out of MN, which took my $470.00 fee and records, and went bankrupt!) Herbalife drops, Slimfast, etc but I don't have DOCUMENTATION. Like my Weigh****chers books as for one thing. I moved from WI, and didn't feel I needed to hang on to those things forever. So, with most of my household, I tossed them when we moved. All I have from Weigh****chers is my Points Slider. I am currently under "dieting quarantine" anyhow since the beginning of April and will be until Oct. which will make it 26 weeks. That SHOULD give them sufficient time for them to say THAT isn't good enough, or change their requirements again. As for this whole dieting fiasco... ACK!! I've heard a BAZILLION different versions...2- 26 week diets, 3 diets in 26 weeks. I KNOW for a fact there is NO 12 week diet. They require 26 weeks total, when it's all said and done. I'm doing ONE DIETICIAN PRESCRIBED diet, weighly in MONTHLY and they can bite me. Especially considering that when I called them back in Feb., there was NO SUCH MENTION of dieting required at ALL, BOTH times I called. I'm so tired of their games and trust me when I say, the war has only just begun. If they want to play hard ball, lets bring in the Insurance Commisioner too... Over this second denial, the guy told me over the phone was that they didn't feel it was medically necessary. I'm not entirely sure WHAT that means or entails. I have YET to recive the actual 2nd denial letter, tho he said they mailed it out June 13th. I still didnt get it today. Until I can read that, I can't tell you for sure what the reason was this time around. One very positive note, if worse comes to worse, I can get single BCBS coverage with my new job as of Sept. Now, HOPEFULLY, they won't have an employer written exclusion for WLS. (Wouldn't THAT just be my luck??!) BCBS people get approved in 2 weeks or LESS!!! (most in 2 days!!)