need advice re: cigna hmo and diet

I was denied 1/7/04 by cigna hmo orlando for not having 6 months of a physician weight loss supervised diet even though I sent 10 years of medical records which document weight history, documentation by MD' s of being on Atkins, seeing a nutritionist, etc. I also typed a 2 page letter listing all diets I have tried weight loss and gain. What more can I give these people? Can someone please explain how a 6month diet makes this surgery a medical necessity or not? I have Type 2 DM, HTN, GERD, arthralgias BMI current 47.5 and I am 29 years old. Doesn't the fact that i am morbidly obese, have comorbidities, and health risks from being overweight make this a medical necessity how does a 6 month diet, physician supervised change anything? Cigna health services is unable to answer this also. They just kept repeating you need a 6 month physician diet to all my questions. Initially I was ready to get an attorney involved and now I am wondering do I just complete the 6 months and see what happens then. My concern is this being a catch 22 if I loose weight will they deny, if I gain do they deny, if I maintain do they deny? I have been trying for 10 years nothing works anymore not even Atkins. I am currently on a 800 cal diet precribed by my Dr. in Oct. Here is my other concern, I recieved a letter from Cigna sat dated 1/5 giving more 40 days to provide the diet and a nutrition consult, so how did they turn around and deny in 2 days without giving me a chance to turn in the nut consult and the current diet I am on. So, what do I do next, do I wait and see what they say in 6 months or do I contact a lawyer now? Thanks in advance for your help and advice.

Michelle---- As frustrating as it may seem. I would go ahead and wait the 6months...that is do the 6 month siet and apply again. I too have the same problem, but the only difference is I am 30 and have to deal with BCBS of FL. Good Luck to you !!

Michele, How helpful is your primary care doc and your endocrinologist. Ask them to submit to Cigna a progress note from their office with the diet they recommended, weigh ins and progress along with you appeal letter. It would not hurt for you to go ahead and consult an attorney. If you can show that you have the diet history then by all means, see your lawyer. I feel that really, really soon a lot of these insurance co are going to quit paying or it. I would waste as little time as possible as cigna is coming our quarterly with new requirements. They came out Oct 1 with the doctor supervised, and Jan 1 with a lot of exclusion on different policy holders!! Some humana and most UHC policies are now excluded! It would not hurt to get some really good legal advise!!! Susan Williams Patient Advocate Lap WLS Jacksonville, Fl

Hi. I had the same problem with my Cigna HMO. My doctor finally had to do a peer to peer call with Cigna Dr. After that phone call call, I was accepted immed. Good Luck! Hope this helps. Perla