Denied Again

Hello everyone. Well, after re-reviewing my case claiming that I did not have 6 months of weigh in's, CIGNA has issued a 3rd denial now claiming that it was not enough that I did the weigh ins and saw my doctor on a 6 month basis. Now they are saying that I did not follow a program even though my doc had me on a 1500 calorie diet for 6 month. It is always something huh? So now I am getting kicked into appeals and another month or so of waiting. I think at this point I am to pissed off to be upset. Does anyone know of a patients advocates groups. Is there any advise anyone has about appeals. Thanks everyone. Sam

Samantha, I too have Cigna and am currnetly going through the appeal process has well. I called back in May to find out what their requirements were and was told at that point about the 6 month diet. I kept a daily food diary for 6 months and was weighed once a month by my PCP. All this info plus her letter of recomendation was forwarded to the insurance co. along with the surgeons info. They came back on Dec. 29 with a denial stating that I needed to complete the diet with someone else other than the Dr. performing the surgery. How thick are they? My PCP sent the info re: the diet and my surgeon sent the info re: the surgery, their names are not even close for Cigna to be confused. I think they just flat out are refusing everyone regardless, they will always find a way not to pay!! Yesterday in the mail I received all my appeal info back saying that they did not know who I was? My request was unidentifiable? So Today I am faxing it to them and re-mailing incase they can't read the fax. I am to mad to give in to them and I'm going to keep fighting, maybe persistance will pay off. Keep me posted as to your progress and I'll do the same. Lots of Luck Terri

I would hire a lawyer just to give them a call, that might be enough to make them change their minds. What they are doing to you is stupid! You might also want to talk to whoever deals with insurance, the one that sends you the packets and stuff. I have insurance through my hub and at his job there is a person he can asks questions of. Good luck! Theresa

{{{{{{{{{Sam}}}}}}}}}} I am sorry to hear of your ongoing problems with CIGNA, but not surprised. They pull out all stops. Today, I received a denial from them to pay for an appointment with a specialist that I had obtained a referral for. The reason they rejected it was because they claimed I didn't have a referral. Games. The article you posted was interesting. I had heard CIGNA got in some big trouble with Maine, but hadn't read the specifics. You hang in there, Sam, your day is coming! This will happen for you and I bet you'll be chasing Ari come summer! Love, Jo

I know a guy that has just became a member of Obesityhelp, and he is going through the same thing right now. he has been deied once and is appealing it. best of luck to you and all the people that have CIGNA.