DENIED BY CIGNA FOR A SECOND TIME!!!!!

Well, I think I'm calmed down by now! That's why I'm posting at 12:30 at night. I was supposed to hear from CIGNA today about whether my appeal for surgery was approved. I did not get anything in the mail, so I called and was told that the computer was saying that a decision was made on July 29th. I sent by appeal on July 28th. I received a letter from CIGNA last week stating when they received my appeal (July 28) and that it would take 15 day's from then, which would mean that I would hear on Aug. 12th. In the letter it was also stated that a physician reviewer and designees who were not involved in the original decision would review the appeal. WELL, THE DECISION WAS THAT AGAIN I WAS DENIED!!!! The person I spoke to read me the letter (that has not been sent yet) and it was pretty much saying that they felt the reason for surgery was cosmetic. Now I will have to see this letter myself, but 1) If they are saying that it would take 15 day's to come to a decision and I'm being told that they decided this on July 29th that does not sound like it took much of a committee to make a decision 2) I think I made myself pretty clear in my appeal letter that I needed this surgery for health reasons. I'm diabetic (a letter of medical necessity was sent from my PCP) I have sleep apnea and GERDS. They made this decision so hastily that I don't think that they even read the appeal. 3) They did not have the decency to contact me by the date that they said that they would and they made me wait for 2-weeks when they made the decision in one day. Of course I'm being told that I could appeal this again, but sending paper work back and forth is just wasting time! I spoke to the Insurance Commissioner's office earlier in the week and she pretty much told me that the commissioner's office of DE has no jurisdiction with my husbands insurance (CIGNA) because he works for Getty Petro. and it is based in New York and considered private since it is voted on by the employee's though his union, so I'm going to see if the union can do anything. I'm sorry for venting, but I don't know what else to do! I'm running out of hope here! I'm sure this is what the insurance would like to hear, but this game that they are playing is getting old. I hope someone out there knows what to do. I'm at the end of my rope!!!! Rosemary

Rosemary, I am so sorry for you. Any chance your husband can change his Insurance coverage.? I know Coventry will not cover Gastric Bypass and I know some of the girls switched to other insurance just so they could have WLS. It takes awhile. Gosh keep trying. Don't give up. Let the anger give you the energy to hold on and fight this if you need to. I was denied 1st go around with Aetna. I put my appeal letter in my profile. You can copy it if you need to. Datewise it was around Dec 30th, 2003. I included my attempts at weight loss. EXP: Weigh****cher's numerous times, Nutra-system, Isagenix, USANA, LA weight Loss and I included the drugs I had been given over the years too. Didn't even mention the quack I went to for weekly shots of pregnant woman's juice of some kind. Gosh what we won't do to loose this blessed fat. I also included my physical fitness attempts. Hang in there. What is your BMI? Seems like the insurance Co's are really looking at the BMI & the co-morbities. I'd say you qualify on the co-morbities, sleep apnea and diabeties alone. Anyway good luck. ((HUGS)) Elissa

Thank you Elissa: For the words of encouragement! My husband can't change his insurance coverage, because he is union and I guess it has to be voted on when his contract is up and I don't think they were given any other choice but CIGNA. I also put my appeal letter on my profile (Not that it has done me any good)! You can look at it and maybe give me some suggestions, but I don't think I could have made it any clearer or done anything else to improve my chances of approval! The only thing I can do is try this again when I take employment (I have 3 Job prospects I'm working on now)! I just am bummed out about how long this will take and the fact that I will have to start all over again!!!! Rosemary

ROSEMARY SWEETIE I AM SO SORRY TO HEAR ABOUT THIS,TIME TO FIGHT MORE GIRLFRIEND.YOU NEED ANY HELP WITH THIS JUST ASK OK.HEY ALSO IF YOU CAN'T GET NOWHERE WITH THE UNION TELL THEM IT'S TIME YOUR GOING TO GET YOUR LAWYER.THIS IS WHAT IT MAY TAKE.DON'T STOP KEEP ON FIGHTING.I FEEL THEY DIDN'T GO OVER YOUR APPEAL TO SEE WHAT IS REALLY GOING ON.IT'S NOT FAIR.I HOPE YOU MADE SEVERAL COPIES OF YOUR APPEAL LETTER AND DOCTOR'S LETTER ETC,ETC.ASK DR IRGUA FOR HELP TOO AND NICKI,ASK THEM TO WRITE APPEAL TOO.GOOD LUCK SWEETIE.((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))).((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))).((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))).((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))).((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))).((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))).((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))).((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))).((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))).((((((((((((((((((((((((((((((((((((((((((((HUGS)))))))))))))))))))))))))))))))) LET ME KNOW WHAT I CAN DO OK.HANG IN THERE YOUR FRIEND BONNIE

Thank you Bonnie: I'm just down and out right now, but by Mon. I should be fighting mad!!!! I'm going to see what I can do or what help I can get with the union and I will call Dr. Irgau's office to see what if any help they can offer. They have not been much help so far, but maybe they will have a change of heart. I might have to Kiss butt! Something I'm not real good at. We will see!!! OXOX Rosemary

Hey maybe if you tried a nother procedure or Dr. and let them go throught the insurance bit! I went from amerihealth HMO to PPO and I got approved right off the bat! I also went throug a Philly hospitial insted of having it Done in DE they have their own way of doing things at HUP! Good luck to you I wish you the best and please don't give up! God Bless My Joi-Joy

Hi Rosemary, I was denied 2 times, hang in there. Let your anger and determination get you through this. Did they give you any guidelines you could follow in order to get approved. For instance they told me I had to have a Dr. supervised diet for 6 months straight in the past 2 years, I turned in the charts from my PCP and in the denial letter they told me it was not consistant. So I just gave in and did the 6 month supervised diet with my PCP. When it was over, I sent it in around Sept 15, and I had surgery Oct 6. They want you to give up, don't, keep fighting, try to find out what they need from you to get approved. Keep us up-dated, I will keep you in my thoughts and prayers. Hang in there, just a bump in the road!!!! Hugs, Dana

((((((((((((( Rosemary )))))))))))))))) So sorry this is happening. Keep trying. Call them again next week to make sure that this July decision is not only regarding the first time they denied you. As you say, one day is too soon for them to make such a decision, that seems to me to be documentation from the first time. Call them back in another week and ask for the status of your appeal, maybe it'll be some good news - can't hurt. Anyways, keep trying all that you have to do as it is well worth it. Dianne

Rosemary: I am so sorry to hear that you were denied again. Please don't give up! Your in my thoughts and prayers. Kim