CIGNA denies again

I have been denied on appeal for surgery because of medical necessity and compliance with a weight loss program that can weigh me once a month (BMI=66; 1200 calorie diabetic diet). So my PCP asked for a nutritionist and a scale that weighs people over 350 pounds. This has been denied because it is not medically necessary. This has just gotten ridiculous! I am in the process of completing the second appeal process, mailing it in. I am including a letter from my PCP, chiropractor, medical records from the hospital, orthopedist and PCP. Does anyone else have any suggestions? The second appeal letter includes information on ADA and that I will file a complaint unless the surgery is approved. If you have CIGNA as an insurance company, CHANGE!

I was approved by Cigna on my first attempt, but I had atteneded weigh****chers for 8 months and had their booklets with weekly weight. I also took charge of the documents that were sent to the insurance making 3 pages of previous diet attemps in a chart form. My primary care physician said that Loveless was going to be starting a bariatric unit in the summer. Maybe this is a delay tatic. What surgeon are you going to? They should be able to guide you through this process. Just keep up with the appeals. I think there are three levels and I have heard of people finally being approved in the third level. Look on your policy, I belive at your BMI it just needs to be deemed medically necessary by your primary care and all this other jazz about documented weight loss is for people with lower BMI. If have gone to your doctor monthly about weight issues and discussed diet, update your records to include those facts. Jan

Hi Jan