2nd Appeal Committee Meeting/Conference Call!?

Okay, folks - I need your help & support. I received a UPS Next Day Air letter from CIGNA today notifying me that the Appeals Processor has scheduled a committee meeting to review my second appeal for WLS.  The meeting is next week (8/8) and they've invited me to attend via conference call. **Has anyone out there ever had to go thru this?!** And if yes, what insight can you give me?! I am almost beside myself - I want to be overwhelmingly optimistic, but right now, I don't know how I feel other than I want this tool SOOOOOO bad!  (Words of encouragement are also accepted - thank you!) Hugs & stuff - Hellen

Good morning! I hate to hear your having to deal with the insurance company. It's amazing how they can control our lives the way they do, but unfortunetly that's how it is. I don't understand why they can not see the benefits to WLS compared to being morbidly obese and the medical problems it can cause. I know someone who has been dealing with CIGNA for over a year and still hasn't been approved, but she hasn't given up and is still fighting them. I say don't give up either, keep fighting for your health. I guess they prefer paying out for  doctors, medications, and a life time of medical problems, instead of something that can help a person regain their health. I can't begin to tell you how much WLS has helped me, not just physically but mentally also. It's like you become a totally different person. I can do things now that 9 months ago I couldn't do, like walk up stairs ,my knees were so bad I couldn't go up them at all,now I can run up them, I use to get out of breath just walking a short distance. I can tie my shoes without huffing and puffing like I just ran a marathon. My back doesn't hurt like it use to, and I can sit on the floor and actually get back up without any help. My self esteem is so much better and people actually talk to me now instead of walking past me like I was invisible. I have been able to get off my Prilosec for acid reflux and I have been on it for 8 years. My blood pressure went from being in the 160's over upper 90's to 106/68 (thats what it was yesterday when I checked it at work, it has been even lower than that).  So, yes WLS might have  risks, just like any other surgery does, but look at the benefits to having it.  I'm sorry this is so long, but I now how your feeling and just wanted to tell you to not let it get you down and keep fighting for what you want. My prayers will be with you, so keep in touch and let me know how it turns out. Hugs and best wishes! Mary

Thank-you very much, Mary for all the supportive words - you definitely hit on a lot of issues that I'm going thru now (physically).  There's a lot of common ground in what you said, so again - thanks.  I'll post again after Wednesday's call. Hellen

I have never heard of such a thing. Insurance companies are a nessasary EVIL. I'm so sorry that you have to jump thru hoops in order to get healthier. Hang in there, that is really all that you can do at this point. Just know that there are hundreds of people on this site that are behind you and praying for you to get what you deserve, a right to health care. I was just one of the lucky ones, I got approvedfrom BCBS in two days. That just doesn't seem fair to me, at all. When your on your conference call, have all your facts ready..illnesses, meds...dates...try to be as informed as possible, and speak up. Let us know how it goes. Good luck!!!

That's so funny that you said 'jump thru hoops'!  That's exactly what I told my partner when I first got the letter - but honesty, I know I'm not the first person who's had to go thru this & definitely won't be the last until the insurance people realize we're fighting a disease here - not weak people who just sit around & overeat.  Thanks for your support! Hellen

In all the reading I did here as a pre-op, I do remember an instance or two where someone had this experience with their insurance company.  Try doing a search in the box at the top of the page (on OH) and maybe you can find a few of them.

I wish you nothing but success in your effort, you know that.  You are a very intelligent and deserving person ... you hang in there, and don't give up.

So far I've gotten a lot of good information & encouragement from everyone who's answered my post.  I've got a few days before the call and believe me, I'm getting the stuff together and gonna be prepared!  Thank-you very much for the good words... Hellen

that sounds promising! I would call ur doctor and let them know what theyre wanting to do. he might can give some pointers as what you could say to help or what not to say to hurt .. our insurance had an exclusion and wouldnt even hear of it so its good yours is considering it!!! GOOD LUCK Let us know how it goes!

Lisa (Dr. Byrne's patient coordinator) also said "that sounds promising"!  So with two beautiful, intelligent women saying the same thing, it must be true...  Thanks, I'm getting all the documentation together I can! Congrats on the plastics approval - you are gonna look dynamite! Hellen

Hey Miss HELLEN!! Have NO fear... the second level appeal is just a formality. They cant use the same people that did the first one, so they have some new folks doing this one.  Cigna has a coverage policy on WLS and as long as you completed all the steps, theres not much else they can say. The only time the coverage policy doesnt matter is if an employer specifically excluded something... but yours didnt... and so ITS ALL GOOD!!! Just be informed with the policy itself... YOURE ALMOST DONE!!! KEEP YOUR EYE ON THE PRIZE!!!!