CIGNA denying DS

Let me begin by saying, I HATE CIGNA!!  They have approved me for WLS but they are denying the Duodenal Switch saying it is experimental/investigational.  Even tho' the last appeal packet I sent was 109 pages with case studies, including the Medicare decison that they are now covering it as well.  Well, I had a conference call last week with CIGNA's "professional appeals board" and reps from my surgeon's office.  Well, I wasn't impressed.  The doctor and the nurses didn't seem to know much of anything about WLS and didn't know the difference between RNY or DS, and I SWEAR I heard one of them say "what is a pyloric valve" when I mentioned DS preserves it where RNY doesn't.  Now I don't expect any lay person to know that, but you would think someone in the medical field would!  They have now offered an external review with either Hayes PLUS or MCMC.  Does anyone here have any advice?  Have you had an external review with either of these companies?  Any help would be greatly appreciated!! Lyndia

Hello Paul, I want to thank you for taking the time to reply to my post, especially in such length!  I appreciate the thought and the time.   I had VGB done back in '97 and this will be a revision for me.  My surgeon has suggested the DS instead of the RNY because it is a more restrictive surgery.  And yes, you are correct, all surgeries are tools, but you can buy a "value" brand hammer at Wal-Mart and it will fall apart half way through building your house, or you can buy a Craftsman and have it forever.  LOL The thing with CIGNA is the HAVE approved others for the DS before me, which is why I am fighting so hard.  If they can approve it for those people, then why deny anyone else?  It's not right, it's not fair and I'm going to fight for all I'm worth because I AM worth it. I have done over a year's worth of research and I feel in my heart that the DS is the better choice for me.  If my surgeon also believes this is the right surgery for me, then who is CIGNA to say it isn't?  My surgeon also does the RNY so she is going to get paid regardless, but that's what I like about her.  She is not "pushing" one or the other on me.  She has given me the facts, has given me her professional opinion and is letting me make the decision.  I think it is wrong for the insurance industry to be playing with people's lives, just as in the case of the lady in TX you mentioned.  While she was fighting with the insurance co. she lost her fight with obesity.  And in my opinion the insurance co. helped seal her death warrant. Thanks again for your input and thank you for the link. I will definitely check it out. Tak care and God bless you! Lyndia