NAN2008!!! YOUR LETTER GOT ME APPROVED!! BY CIGNA!

 OMG!!!!! I am sooooooooooo excited... after being DENIED on August 16th, 2010, my Primary Care Physician signed off on a letter that I got from an Obesity help member named NAN.  My APPEAL was sent in on Monday August 30th, and my surgeon called me today and said "THAT MUST HAVE BEEN ONE HELLUVA LETTER, BECAUSE CIGNA HAS APPROVED YOU FOR WHATEVER WLS OF YOUR CHOICE!!!   I go in on Sept. 14, 2010 for blood work, to see which surgery will be best for me, I am looking into Lap-band, or the  VSG. Thank you all, for your concerns, and helping me get through this thing with fighting with the Insurance Company!!!! I will update you all on a tentative surgery date soon!!!!   GOD IS WALKING RIGHT BESIDE ME ON THIS JOURNEY, IF I MAY FALL, HE WILL BE RIGHT THERE TO LIFT ME.   

 NAN... thank you from the bottom of my heart!!!!  Your letter should be TRADEMARKED!!!!  

You are so very welcome!!!!  I am happy things turned out so well and you got your approval!  I hae been so happy with my choice of RNY and my daughter had her RNY in May and is down 75 lbs !!  We also appealed her denial and now look where she is!

Congrats!!  And keep me posted on your surgery!  I love hearing stories like yours and glad I was able to help!

Nan

Hello and congragualtions. I was just denied by my insurance company for a RNY yesterday and was on this site looking for some advice and saw your post. Is the Nan, My Appeal Letter posted on here and if so could you tell me where I can find the sample?? I am trying to not let this denial get me depressed and I could really use some help. I wish you the best of luck on your WLS journey.  Thanks! Molly

Here is the sample letter from NAN2008,  changed it around to fit my cir****tances and took it to my PCP to sign it. The Surgeon faxed it to Cigna Insurance Monday Aug 30, and as approved Friday Sept 3rd!!!  I am sooooo excited, I hope this letter help you as much as it helped me. God luck.



 January 01, 2009   
RE:     Patient’s name 
DOB:    

To Whom It May Concern:   

This letter is in support of bariatric surgery for xxxxx xxxxxx.. She has had a life long struggle with obesity and has attempted numerous methods of weight management without lasting results for over xx years that she has been a patient with us. She has tried various weight loss methods, including Weigh****chers, Atkins, Richards Simmons, Liquid Protein shakes, Adipex, Slim Fast, Diet Center, Protein Power and the 6-Week Body Makeover. She has lost significant amounts of weight on some of these programs, only to gain it back each time. She has exercised in the past, including exercise tapes, walking on a treadmill, and following a cardio and strength training program. She has a strong family history of obesity, hypertension, Type II diabetes, and heart disease. At this time, xxxx is extremely committed to pursuing bariatric surgery.  xxxxxx has been diagnosed with morbid obesity, along with co-morbidities of Osteoarthritis of the knees and Hypertension. 

Her current weight is xxx pounds and height of x’x". Her BMI is xx. In the past couple of years her weight has fluctuated between xxx and xxx pounds in our office.     I believe that xxxxxxx is extremely motivated and knowledgeable about bariatric surgery and committed to making this a lifelong change. Her ideal body weight and weight loss goal is approximately xxx pounds. She is currently taking no medications and has no known drug allergies.   

xxxxxx began a 3 month multidisciplinary surgical preparatory regimen on xxxxx xx, 2008. She has been in compliance with all components of the program and at this time, I feel that she has exhausted all of the options available to her other than weight loss surgery. I find this surgery to be a medical necessity and have referred her to xxxxx xxxxxxxxx, M.D., who specializes in laparoscopic Roux-en-Y gastric bypass surgery and offers extensive pre and post operative follow-up care.    Should you have any questions regarding this recommendation, please feel free to contact me directly.   

Sincerely, 

Xxxxxxx   xxxxxxxxxxxxx, M.D.    
Address City, State, zip Phone#

if is not to forward of me; may I ask why you were denied?

Wow that is so exciting.  I am going to try this letter as well.  I got approved on Aug 31 and started the whole process of testing and even was on the liquid diet for a week and boom get denied 2 weeks later.  I have been just devastated.  I wouldnt have been so depressed or upset if I got the declination first, I was prepared for a battle with the insurance company.  I have been calling anybody and everybody and it looks like the long and short is they dont like that I started taking Zoloft in April of this year.  Insurance company said they didnt like that i was being treated for Chronic depression..... What!!! since April.  Gees, i am a single mom of two teenage boys (both of which are ADHD/ODD) and things have just become overwhelming.  Between my declining health and raising kids I get very high anxiety and felt i needed some help for now... I know the insurance company is just looking for a way out, but I am looking for a way in and with this letter I hope to succeed just as you did.  (sorry for the long post :)  I am just frustrated and hope like you i will get an approval.

Hey ladies, I am off my way on my JOURNEY.  Initially I was declined because my BMI was under 40.... But I have SLEEP APNEA and GERD. But, because my BMI was under 40 CIGNA still denied me.  I gained... get this......  7+ pounds (under 10 lbs), and that put my BMI at 40.4 (I am only 5 feet tall). I went in to be re-weighed, and took this letter to my PCP, and the PCP signed the letter, and the surgeon faxed it over on Monday--August 30th, and I was approved on Friday-- Sept. 3, 2010!   

I HOPE IT WORKS FOR YOU, THE WAY IT HAS WORKED FOR ME!!!