CIGNA DENIED 2ND APPEAL

I am livid. Today i found out that my second appeal was denied. I am trying to have a revision done over a failed previous weight loss surgery. In Nov. 2004 I had a VBG. My weight on the day of the surgery was 268. By January of 2006 I weighed 196 lbs. Every month after having the surgery I checked in with my primary care physican to monitor the progess of my weight loss. Every month after Janurary 2006 my weight started to go up. I stopped losing weight. By the time November 2006 rolled around, my weight was 240. I joined a weight loss program but weight loss wasn't successful. So in Feb. 2007 I met with a doctor who does lap band revisions over a previously failed weight loss surgery. So I had my nutrional evaluation, psych evaluation, also provided the notes from my physician regarding the supervised weight loss diet. With that information we submitted request to Cigna. It was denied because they said they didn't have technical proof that the previous weight loss failed and that information provided shows that i wasn't largely compliant with post operative diet instructions. So i had an upper EDG done on Sept. 4th, and the doctor shows that the band has slipped, i have a large heital hernia pouch, and that i even had food that was just sitting there in my stomach. So with this information we submitted it to cigna on Sept 6th, only to be told on Sept. 7th that i was being denied due to the fact that information provided didn't show that i was compliant to the post op diet. Basically that i didn;t lose 50% of the body weight or i wasn't within 30% of my ideal body weight 2 years post op. So i called cigna and asked what was the appeal process now. Said that I couldn't request a meeting with any of there doctors, and a peer to peer review wasn;t an option. stated that i would have to file a national appeal and send it to cigna's appeal board as an urgent request to have the information reviewed immediately. I am livid because they see that the band is sitting right there in my stomach. It has slipped. So what does following a post op diet have to do with the fat that I have a slipped band, hietal hernia, plus my esophagus is raw due to the acid relfux. what do i do from here. Who should i request to speak to at cigna, or should i go with a different doctor? because at this point the revision shouldn't be about following a post op diet. it should be about the facts and test showing i have this band inside of my stomach that has slipped and  doesn;t that post a health risk for me. 

I would suggest checking out www.obesitylaw.com.

Have you tried to go back to the original doctor that did your first surgery?  Seems like he would be the one who would have to fix it.. and your insurance would have to pay for it as a continued treatment.

He is no longer in practice. Has terminal cancer and closed his practiced in Dec 2006 with no referral to any other doctors.

Lyndia (LyndiaIN) fought Cigna and won.  Not sure if her case is exactly like yours or not.  But I know she had to fight them with appeal after appeal.  I think it took her 8 months, but she finally got approved.  She was also a revision, I believe.  You may want to PM her and see if she can offer any advice.

Hope this helps.

thanks for your response. how do i contact her again?

Go to people search and type in Lyndia under the first name.  You'll see her there.  She's getting ready for her surgery in a few days, I think.  If she doesn't answer you right away, that's probably why.  Good luck!