Insurance frustrations

I am so frustrated with this process. I understand that there needs to be a rigorous elimination process for those that are going to abuse the surgery. What I don't understand is how the insurance companies, CIGNA in particular, can keep changing their requirements so they are able to keep denying the surgiers! I was denied once in Feb. of last year by CIGNA due to the fact that I did not have 6 months of a weight monitored program over the past year. I was upset but understood that there needed to be documention. My primary care physician called CIGNA personally to find out EXACTLY what I needed to do for approval, which was be seen every other month by the doctor with monthly weigh ins. Now, after 6 months of that, they have yet again denied my claim. I was astonished. I meet every criterea for the surgery and then some. My primary care doc. called them again personally and they have agreed to review the information again. I am at my wits end. I wish I could just get an answer. I just want to be able to run and play with my daughter instead of sitting inside all the time. Has anyone out there been through this?? I feel so badly for all of the people like myself who are desperate for help that is right there in our grasp but are unable to recieve it because of the insurance companies. In my denial letter they state that rapid weight loss is not the goal of a weight management program. The best ideal would be to reduce my weight by 10%....give me a break. I weigh 400lbs. I just can't wrap my mind around this. I am sorry to complain but I just had to let this out to a group of people that will understand. Thank you. Samantha

They are just messing with you. Stringing you along. Maybe they are hoping you and others they do this to will just give up or have a change of jobs before you can get the surgery done. Cigna is not always the easiest to work with from all I have heard. There was something on the news a couple months ago about them being fined (not sure what state) because they kept lousy records, had no set criterias for approving or denying. They pretty much just winged it. With your doctor behind you there is a better chance of things working out. Do NOT give up. You might want to consult a lawyer, a call from one might do the trick. Good luck! Theresa OpenRNY 7/15/03 235/165/140?135

Hi {{{{{{{{Sam}}}}}}}}, We hear your frustration and DO understand. I am thankful that you can come here and vent. Theresa has much the same feelings as I do regarding the insurance denying WLS - they do it because they can! Scare tactics! And because many people do back off when denied, they deny whenever they can. We know this surgery is necessary for our health and we do NOT GIVE UP THE FIGHT! You hang in there, have faith, this WILL HAPPEN FOR YOU, SAM! Love, Jo PS - Sam, one of my good friends who had weight loss surgery with Dr. Cobean (she had the highest BMI for a woman he had ever done) had her check up with him this past Wednesday. Pre-op, she weighed over 400, this week, she weighs less than 240! She has lost over 200 pounds in less than a year! You hang in, honey - you and your family deserve this second chance - it will happen.