appeal for revision with cigna-sample appeal letters?

Gary S.
on 11/2/04 10:25 pm - spfld, MA
hi all; For a variety of reasons my lap rny has failed. i was the first lap patient in massachusetts and apparently the learning curve worked against me. Lots of complications-vomiting, 5 emergency visits, angioplasty to reopen my entrance and exit, etc. the original operating drs lost the video of the surgery as well as my file, then threw me out of thier offices after 2 post op visits insisting it was all in my head, only to find out that the entrance and exit were swelled completely shut due to scar tissue and trauma. I was-pre op 285, lost 100 lbs in 6 wks (all my hair AND teeth fell out-i was vomiting 70-100 times a day), got to 174 and am currently 225, terrified and depressed. it took me 2 years just to find another doctor to see me. no one wanted anything to do with me as it appears to be a potential malpractice suit. the aweful part for me is that no dr will tell me exactly what is wrong as they dont want to get involved with a law suit. my current dr will only say that it was NOT my doing. He states: remember that you were the first patient of this kind and bad things can happen. very vague. I really wish someone would just tell me what went wrong. If its me, so be it. Now, i WILL admit that im currently caught in a catch 22. The more depressed i get about my weight gain the more i eat. I can eat as much as i could pre surgery and i do. my stomach is 3 times the size it should be. i seem to be my own worse enemy. im now with a doctor that i really dont trust but im kind of using him to get thru the revision appeal process which is very very difficult just to keep the process going until I find a dr i like and trust. cigna claims they dont cover weight loss surgery PERIOD. (I originally had BCBS when i had my surgery 4 yrs ago) I have a series of questions i need help with: 1. does anyone have any sample appeal letters regarding revisions? i could surely use the help. 2. im leaning toward a lap band as it seems to be the least invasive and most practical surgery regarding my issue, but just am not sure...any thoughts? the doctor im with now will only do an open rny which i do not want. 3. anyone know of a surgeon in the new england or NY area that specializes in revisions? im in mass, the supreme expert with the most experience in wls is dr shkora in boston but he refuses to see me (he went to med school with my original dr) anyway, thanks for letting me vent, I feel like ive been twisting in the wind for the past 2 yrs. the newbies on this board are so pro surgery that its hard to relate. Gary in MA
Zoli
on 12/20/04 5:00 pm - Somewhere by the Sea!, CA
Hi Gary, I'm sorry I don't have any info for you, but I am soo sorry for your suffering. I"m still pre-op (in San Diego) and although I have Cigna too, I haven't even applied yet. I can offer to pray for your situation as I can't even imagine how you must be suffering. May the good Lord restore your health and show you the way through this. Z
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