Question:
HELP WITH APPEAL?!?!?!

I WAS RECENTLY DENIED SURGERY. I HAVE WRITTEN A LETTER APPEALING THE DENIAL (PER MY SURGEONS OFFFICE) NOW WHEN I CALL CIGNA TO ASK WHO TO SEND THE LETTER TO, THEY TELL ME I NEED TO CALL THE SURGEONS OFFICE AND ASK THEM???? ARE APPEAL PROCESSES DIFFRENT WITH DIFFRENT INSURANCE COMPANIES? SHOULD I SEND IT TO THE PERSON WHO SENT ME THE DENIAL LETTER?? WHAT SHOULD I DO? THX, KAREN    — Karen W. (posted on October 24, 2002)

October 24, 2002
Your surgeon's insurance clerk should be able to send your letter into Cigna. Also, make sure any new notes or pertinent information that documents dieting or any of your co-morbidities goes in at the same time. Be sure your letter addresses specifically the reasons you were denied and provide any documention of compliance that you can.
   — Cathy S.

October 25, 2002
Yes they are correct when they say to ask the surgeons office. They have provider reps assigned to each provider to facilitate in this kind of thing. Yes each insurance company handles appeals differently. If you send it to the person that initially denied it....they may just send it back or it may get lost in 'routing hell'. Your surgeon has been given the correct address to send appeals to and im certain you are not the first to be denied from your insurance company. Surgeons that perform WLS are very familiar with denial. Its the nature of the game.
   — RebeccaP

October 26, 2002
Karen, I have Cigna POS and got denied first time around and then got approved when I sent my appeal letter. I sent my appeal letter and my PCP sent his in individually. I got a call from a sweet lady and she told me that their was no way I would get approved with just my appeal letter. I had to go to the surgeon's office and make sure that they would send the medical records right away because Mon. was the last day and then it would be up to review. My surgeon's office showed me that they got a fax from her the night before and never did anything about it until I came in asking them why they didn't do it. They finally faxed the records over to her and I got approved within a week. I sure hope you don't have to go through all of this. For one thing this was a new surgeon and his office was learning what to do. After all of that I found out later he was no longer taking my insurance and since then I have called the insurance woman that handled my case and told her I had to switch surgeons. I wish you the very best in this take care! If you still need help with the appeal letter just go to my profile by clicking my name below and scan down and you will see a sample copy of my appeal letter. Take care! Nikki
   — Nicole H.

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