Anyone have experience with an Independent review for an insurance denial/appeal?

I received a notification from Cigna today that my request for an independent review of their denial was being sent to a company called MCMC which I think stands for medical care management corporation. Has anyone else had any contact or experience with these guys before?

Why did Cigna deny you?  I have Cigna was denied as well and I appealed and won.

Hi there-

I was denied for no evidence of mechnical failure of the original procedure. All my EGD and barium swallow tests keep coming back normal but Ive been in agony off and on for the past 2 years with a 10 year old band. It feels like the band and port are both pulling. Ive had to go on strong pain meds for it and yet there is no evidence of mechanical band failure. They also denied saying that weight loss surgery to treat diabetes with a BMI under 35 is considered experimental. Problem is the insurance person put the wrong weight and Im not even DIABETIC!! I have a BMI of exactly 35 right now. I got a letter from the surgeon saying that a mistake had been made and that my correct weight is 230 and BMI is 35. He also corrected the diabetes diagnosis. I have a bunch of other co-morbidities and take 7 meds a day. Ironically, diabetes is the only thing I dont have. The whole thing has been a nightmare. I thought it would be easy with all the problems that I already have. Congrats on getting your surgery done!

 

Basically what happens is that they will get a nurse or a doctor to read your paperwork and medical records and make sure the insurance company is following the policy to a T.  If they are, they will likely side with the ins co.

I wish I would have known about this before you requested a an independent review.  They will have the final word.  I would have given you more info for an appeal.  That would have given the medical professional reason to side with you.  For example, studies showing that diagnostics are not the only issue when dealing with bands.  Scar tissue is what usually causes the most problems that you describe and that can't be seen until they do surgery.

The opinion from the independent review is due in on Tuesday or Wednesday. I will post what the answer is. Thank you for the information.