What do I do now? Obesity lawyer? Appeals advocate? HELP!!
My initial submission for approval to have the DS was denied. There was a peer to peer review today and the decision stands. I was denied by my Cigna PPO insurance because the surgery was considered "experimental" for my BMI. They do cover DS but only for BMI >50. Medical necessity has already been proven because I was already approved for the RNY. The BMI under 50 is my only hang up. I would like to hear from anyone who has used a lawyer or appeals specialist. Also a name and contact information if you were pleased. I would really love to hear advice as to how I should proceed to ensure my greatest chance of success. Diana Cox? I will pay the fee to obesitylaw.com tomorrow if I could just hear from anyone that has been able to prevail in a case like this. I spoke to Kelly at obesitylaw.com today. I asked if she were successful in a case like this before. She said she hasn't had many of these cases and never answered my question. Please, any advice or guidance would be so greatly appreciated.