for Tracy Burch!

Tracy, I had an appointment with my doctor to do my monthly diet and discuss my denial letter since it stated that I needed a letter from my PCP documenting my co-morbids and also documenting I do not have any medical problems that would make me an ineligible surgical candidate. When he read Cigna's denial letter stating I did not have any co-morbids such as diabetes, hypertension, ect. He asked if they were stupid or something since my medical record is full of my diabetes, hypertension and high cholesterol. He also asked me to inquire if they do this sort of thing all the time? His thoughts were that we should complete the 6 months of diet visits (2 down...4 to go) and he will do his letter citing the diet and explicitly outlining my co-morbids as they requested. He would also do a mini physical to assure them I would survive surgery. Of course that will mean we do not submit the appeal until first week of July. But he thinks if we do not do as the letter specifies I will get denied again even if we threaten legal action. This would get me still in the timeframe of 180 days to appeal. I was hoping to submit my appeal sooner but I was expecting the denial to be only based on 6 month diet and did not expect they would want a PCP letter specifying my co-morbids. I never dreamed Cigna would state I did not have co-morbids. I hate to appeal without his letter. I can hang in there for 4 more months and attend support group meetings and get the diet down pat. Do you have any thoughts or words of wisdom? Thanks, Sandy

Sandy, Check your email!! Tracy

Sandy, I had Cigna when I had my RNY. I can tell you that your Dr's advice is 100% correct. To appeal before you have your 6 mos documented PCP visits would be futile. I appealed and had legal representation and the 6 month supervised diet is the one thing that you can't get around. Once I had that 6mos and a well written letter from my pCP submitted, it was approved in less than 30 days. So I acutally think that I fought so hard for almost 2 years and it all came down to the 6 month supervised diet. So definalty dont do anything until you have that complete. Have your Dr write a very specific letter including cpt codes about your co morbidities and how not having the surgery will affect your life. You should write the same thing, how it affects you personally. At the suggestion of one of Cignas National Appeals reps I also sent Pictures of myself through the years showing the prgression of the weight. Hope this helps. Sherri