Cigna denial

I need someone's help with writing an appeal. I have received a denial that my doctor had never seen before: "After a reveiw of the information submitted and the terms of your benefit plan, we have determined that the requested services are not covered. This decision is based on the following: The available clinical documentation does not demonstrate the medical necessity of the proposed bariatric surgery in the absence of: Documentation from the medical record providing evidence of active participation in and resonable compliance with at least two (2) professionally supervised weight loss programs for a minimum of twenty six (26) weeks in each program with one of the programs completed within the preceding twelve (12) months. Programs should include weigh-ins on a regular schedule, at least monthly We have determined that the requested services do not meet the definition of medical necessity found in your benefit plan..." I have a bmi of 53 and am diabetic following a diabetic diet for 3 years. I have been to clinical weight loss programs in the past... no documents exist any longer it was so long ago. I don't know what to do... I am going to join weigh****chers but it seems like a waste of time and money to me. How can they say it is not medically necessary???? Can anyone help me out? Thanks!

I have the same problem with the same insurance co. My bmi is 63 and my health is going downhill in a hand basket. I joined weigh****chers for 4 weeks, but since I have no will power left, it was a waste of money. Let me know if you have any luck.

I have CIGNA PPO and they sent me the exact same letter. What they are looking for is a supervised (doctor/nutritionist) diet plan and monthly weigh-ins recorded in the past 12 mos. for at least 6 mos. They want to have prrof that you are able to be "disciplined" and stick to a plan before surgery so that after surgery you will be successful. If you have food logs, weigh-ins noted. Anything like that, that is what they want. I was denied after 1st letter and after 1st appeal. I had my nutritionist write a letter saying I would adhere to a plan after surgery. I have a 2nd appeal teleconference scheduled for 6/10 where I will plead my case with a panel of 6 people (doctors, shrinks, laymen) over the phone. I will let you know what happens. If I am denied, I will be back at it in November after completing 6 mos with a nutritionist. I don't think they will accept Weigh****cher's. Good luck, hang in there. Donna

There is a great appeal letter on this site. I believe it is at the bottom of the page that says Insurance Co woes. I used that. With CIGNA the patient can't start the appeals process alone. It has to be a doctor that is providing additional info and requesting an appeal. Then if the patient agrees that they want that party to do an appeal it happens. That is what I was told when I sent in an appeal letter on my own.

I am wondering what kind of percentage of Cigna patients are actually being approved lately because from what I understand they changed some requirements on April 29, 2003 and now I am hearing there are "blanket denials" with people receiving basically the same denial letter... It's a little frustrating considering when I started my journey in Jan I would have been approved and NOW I would not be with these requirements.