Cigna turns me down again

I've submitted all the necessary paperwork they have requested the 1st time I was denied. Now what do I do? I'm so frustrated and I believe that's what the insurance company wants you to be so you won't appeal. Do I make the appeal or does my doctor? I really wasn't told why the denial came this time...just says 'not medically necessary'. Am I going to have to go on another 1 yr medically supervised diet for them? The hoops are getting bigger and sometimes I think so am I !!! Get the fork...I'M DONE!!!

Just stay on the diet until your approval. Thats what my nurse told me when I was on my 6th month diet. What are your medical necessarys. It seems like your going to have to prove that. Never give up. Debbie is one to tell you that she fought so hard was denied like 5 times. She never gave up. Do you have sleep apnea.? You possible have it and not know it. Do you have high blood pressure? Just try and get all your medical facts together. Best wishes Barbg

I've proved I have sleep apnea (sleep study including my CPAP info was included), high blood pressure (even went to see a Vascular Dr. who submitted info). I submitted all the diet info they required (2 yrs ago + the 6 month one last year). Thinking this was everything they needed, I have not gone back to my medical dr. (not since he submitted all the medical data needed for Cigna) to put me back on a diet. Really, I don't want to give up but with all the out of pocket expenses I've had + time off at work...I'm drained. Recently widowed with a 16 yr old daughter has not been easy financially and I have no more time off till the end of the year. I really was hoping for the surgery to be by the end of 2006 but my hopes are diminishing fast.

Hello! My first submission was denied. I sent in a second appeal and got it approved. My suggestion is to read the letter...it should state why you did not meet medical necessity and then gather the facts together. I sent prescription receipts to document my blood pressure meds, cholesterol meds, and insulin and diabetes pills. They also told me I did not have meet medical necessity as I did not have any comorbid conditions. They could not say that when I sent the prescription receipts for the meds that they pay for. I also sent the Cpap rental receipts that they pay for. Hang in there. It might take a level 2 appeal to get this approved. Sandy

Here's the reason Cigna denied me again...The 6 month medically supervised diet was in letter form mostly. All the information that insurance needed was mentioned but only his notes from my file mentioning the 1200 low calorie-low fat diet in 3 out of the 6 months. So I put a call into my PCP but he's a good one for not returning calls. So my thoughts were..why does Cigna fault me on something I have no control over? Then I got a little mean and thought why do I have to go through this because of my PCP's incompetence. But I'm not the PCP... I don't know how he does his notes. That's not for me to question. Am I ranting? Should I be angry at my PCP? Can he call Cigna even though his not my surgeon?

Well I would think he could call Cigna. I am not sure how much that would help but it might be worth a try. I had the office staff copy each one of the monthly notes and made sure they had in there the diet teaching, ect. when I submitted my appeal. I also sent the Cigna receipts where they paid for the dr visits. If you did not keep those...you can copy the claims off of mycigna.com from your acct. Sandy