Got the Denial Letter Today

Well folks I finally got my denial letter. My denial reasons are The information provided does not establish the medical necessity for weight reduction surgery at this time. There is no documentation of at least one recent professionally supervised diet of at least 26 weeks duration with at least monthly weigh ins. Per Cigna clinical tool for Bariatric surgery. Now I have to write an appeal letter (which I totally suck at) They have my 28 weeks of weigh****chers. I have GERD, Sleep Apnea, Arthritis in the knees, hips and ankles. Constant low back pain, peripheral Neuropathy. All of my weight is centered in the middle portion of my body and I have been obese since I was a teenager. I even documented diets from 1983. I think I am just feeling a little defeated today. Yesterday I was mad, I just need to get there again I guess. I would appreciate any help anyone might have to offer.

They denie everyone. Send in the appeal letter. Your co-morbids are enough for surgery. Try to see if anyone has an appeal letter that they might be willing to share with you. Good luck, Tanya

come to our cignasqueakywheels message board @ yahoo. We have a WEALTH of information there, and we'd be glad to help you and have you. I'm sorry for you...I'm right there with you today. (my external was denied today) Michelle

Hi Tamara, I was just looking around (I'm normally at the Texas board) and saw your post. I know you are disappointed (and I'm worried about being denied for that very reason). After 30+ years of dieting I realized that each diet only made me heavier in the long run so I haven't done as much Dr. supervised dieting in my recent past as I did in my earlier years. My PCP is VERY supportive and told me IF my insurance denies me because I haven't been on a supervised diet then she will put me on one, and after the allotted time I can re-submit. So you might want to go ahead and get on a Dr. supervised diet but I would DEFINATELY appeal. Statistics show that ONLY between 1-5% of morbidly obese people who lose weight are able to keep it off. Those are not promising odds and we should be required to keep putting our bodies through these up and down diets There are also numerous credible places that I've seen that say you are better off to NOT LOSE the weight than to lose and regain (yo-yo). It may not work but I don't understand why an insurance company would want us to put our bodies through more abuse (yo-yo) when your other criteria shows you need this sugery. I have done some documents (linked to my profile) and you are welcome to look through them and use any information that you think might be helpful in your appeal. Good luck and wish me luck that I don't get denied. My papers will be submitted next week. another Tamara (in Texas)