External appeal - How so I handle this?

I've just been informed that I have to ask for an external appeal. I have no idea of how to handled this. Do I send a letter or do I just participate in a teleconference? I met my 6 months Doctor's supv. diet, nutritional eval, and physc eval. How do I argue the medical necessity argument that Cigna says ther is none. I'm 463 lbs, asthma, severe obstructive sleep apnea, high blood pressure, severe knee & hip pain. I don't know how soon these things happen and if I can afford legal help. If someone has went thru this please reply. Thanks, Tom

Tom: I see no one has answered you, so here goes.  I do not know specifically how the external appeal goes.  You should call your insurance company and ask for their guideline/procedures associated with an external appeal.   If you cannot affort legal help, make sure you get the insurance's policy in writing.  Get copies of any and all of your medical records that will support the diagnoses of all your co-morbidities and index them so you know where everything is right away.  Also make a packet of this information to send again to the insurnace company prior to the date of your appeal so that if are able to do the conference over the telephone they are looking at the same documents you are while you are talking to them.  I don't know if you had your PCP and/or surgeon write letters to your insurance company yet, but do so prior to the appeal and send those in also, keeping copies for yourself.  I would go ahead and write out whatever it is you want to say to them.  Several people have letters you could probably use to base yours on.  Be medically precise and unemotional.  They will not respond well to an emotional plea.  Use your medical data to support your contention that your quality of life is almost non-exsistent and that your medical conditions related to obesity are causing serious deterioration of your health. Sorry, I can't help more, but I didn't have to appeal.  I suggest you cross post this on the main messageboard as it gets more traffic and you might get some better answers than mine.  Mention that you have Cigna in title of the post, so that anyone with that insurance will see it and may be able to help you out. Good luck,

Tom, you need to request it from either your plan or the State.  Read the policy and the denial letter.  There might be a special form you have to complete.  Complete the form, and send it certified mail to whoever is supposed to receive it.  Plus prepare a short letter to go along with the form explaining why you should be approved.  Also, submit copies of ALL of your medical reports.  Do NOT rely on the doctor doing that because they sometimes forget or miss a deadline. Also, medically necessary is easy.  It is something that is to be determined by your doctors and you, NOT an insurance company and that is your argument.  YOUR doctors determine this to be life saving and medically necessary.  Too bad on CIGNA if they dont think it is.  They're still citing 10 year old research in the CRTs.

Gary, I maybe contacting you shortly. I spoke to Cigna today and they are sending me the paperwork for me to make the request for an external appeal. I do not plan on sending it in until I have the supporting documentation from all of my Doctors and then I plan on hiring someone like youself to represent me, if I don't I beleive I would be too emotional and not do it correctly. I know I have the life threathing conditions being super obese at 463 lbs with the current co-morbidities that I have. My ENT Doctor already told me that he was suprised that I hadn't alreay died in my sleep. I don't care to die, I would prefer spending it with my wife of 25 years and getting to see my grand kids. I'll be making my decision shortly. Question is can you afford the time in the next month or so to re-present me? Thanks for the reply, Tom

Gary, do you have the time to handle an external appeal within the next month. Please let me know I really need help, I've met the 6 month requirement for a Doctor's supervised diet, I've had the nutritional eval, I just need to justify the medical necessity. Damn I'm 463 lbs, BMI of 74, asthma/Bronchitis, hyper tension, severe knee and hip pain, eating vicodin & sleep tabs, severe obstructiive sleep apnea ( O2 levels down to 55% ,most of the time low 70's on CPAP & O2 at night), I need help to prove medical necessity. Thanks, Tom