Cigna and 2nd appeal process...

Anyone that can help me, I am so confused...on Monday I called insurance and they said I had been denied my first appeal.  I called my lawyer and she immediately faxed in the paperwork for the second appeal.  My denial says I have no medical necessity. According to cigna's process:

You will be notified of the appeal decision. If you're not satisfied with the first-level decision, you may request another review, called a "second level appeal." If the appeal involves a coverage decision based on issues of medical necessity or experimental treatment, a committee will conduct this appeal review. The committee will usually consist of at least three people: a physician reviewer, nurse reviewer, and a non-clinician. All committee members will not have been involved in any prior decision of your issue nor be subordinates of previous decision makers. You will be notified in advance as to when the committee meeting will occur, and you or your representative can present your position to the committee by phone or in writing. For benefit coverage related appeals, a full and fair review will be conducted by someone who was not involved in any previous decision. Provide all relevant documentation with your second level appeal request that supports your position that the previous benefit coverage decision should be changed. In urgent cases, the review and response will be expedited.

I called today to see if a date had been set yet..and was told that then 2nd appeal was pending and there was  note that a decision was due by eod today.  No call was set...and we weren't notified so that we could present our case.

Do you think the "decision" by eod today is the date? Or are they just skipping that and going to make their own decision?  Do you think this is good or bad??? I mean, I'm happy, even if it is a denial, that just makes us able to jump to the Independent Review faster -- the place my lawyer feels I have the best option. 

Anyone who has experienced something similar and can help would be appreciated.

I am sorry that you received a denial notice, but don't give up.  I can't help you with the appeal process as I have not received a denial yet.  I also have Cigna and have been waiting for 4 weeks for an answer.  How long did it take for them to give you your first letter of denial?

Thanks.

In my experience, Cigna was very picky about the dr's notes on the 6 mo. diet. I got denied 3 yrs ago and just gave up.

Last Sept I decided to try again and at each visit I asked the doc to please make notes on the diet/compliance, exercise, problems with comorbids, etc.

This time, I got approved in  a week. So don't give up! Later when I spoke with a Cigna rep that works specifically with our company, she said I could have gotten my doc to write a letter explaining his proceedures and he could ammend his notes... Now, I didn't try it, I was just sick of them, but you might. But if 2 of your visits list something other than weight control, it still might not work. On my last try, no matter what, I told them I was there for diet!!! LOL.

Good luck to you,

Sara