Hello,
I just got  denial letter and I was wondering how your grievance letter went? Its been about 3 weeks since you posted your questions. Any information will help.

I sat in my car and cried holding that letter! The "medical director" who denied me after "carefully reviewing" my records decided that I have a "Lack of Medical Necessity"!! What do I do now?!

Thanks!

 Hi Nan!

You are completely correct.  After posting this, I got BACK on the phone with the surgeon's office got more info and then marched down the the HR department at work.  Someone is now looking into a personal appeals option for me as my employer specifically excluded WLS from our plan.

I'm so certain that this is something I need to do that I'm willing to bite the bullet IF a personal loan is necessary but I'm not going down without a fight and am going straight to the top!  

Thanks so much for the response! :)

- Amanda

 Hello All!

I'm new to the forums as I have been viewing the site for a bit now.  I've just started the weight loss surgery process and had my first consultation today.  I've been so excited!  However, for some reason, I've been feeling like I was not going to be able to take the next steps due to insurance.  Lo and behold I got a call a while ago from the surgery office saying that Aetna has no provision in my plan to provide for any surgery.  

I feel like there was no explanation other than "they won't do it" and now am feeling forced to look into financing options.

Has anyone else dealt with this?    I am so blindsided that I'm unsure of my next step when I know this is something I need to keep looking towards doing.

Any input would be greatly appreciated!

Hello everyone, I just wanted to know from the people who have gotten their surgery approved through BCBS in Texas, if it was a easy or hard process? Also what kind of documentation does BCBSTX approve and doesn't approve? Also, how long was your medically supervised program? Thanks.

On the document on Cignas own website it states that Weigh****chers is sufficient. Not sure if this link will work but here it is.

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

The info is on page 2. "It does state it needs to be in conjunction with a physician or registered dietician." then followed with "For individuals with long-standing, morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can be demonstrated"

You may be able to appeal.