Question for Gary

I was wanting to know if you have any knowledge of people with heart problems getting denied from having WLS and never getting the approval? I have 3 heart valves leaking and two of them have gotten steadily worse since May 2000. I see a cardiologist every 6 months and he said if any enlargement shows up I'll be looking at getting at least 2 valves replaced. I'm wondering if Cigna will push the denial with me and risk paying the larger amount for heart surgery. There is a good chance that losing weight will pospone my heart surgery, maybe I'll never need it. Thank you in advance!

Laura, you can email me or give me a call, I normally don't like posting legal advice but I will tell you that you should talk to your surgeon. If he and the cardiologist have cleared you then as long as the surgery is medical necessary you should fight CIGNA on those grounds. In fact, if they clear you and this surgery will help your heart, a delay could expose CIGNA to liability depending on your State etc.

Ellen is correct. Talk this over with your doctors and if clear, fight CIGNA on the denial. Don't give up. Gary

I've just collected the packet from the surgeon and got a letter from my PCP and waiting on the letter from my cardiologist. So I haven't gotten to the sending in the claim yet. But I was wondering how big a fight I was going to have or (God willing) NO fight at all. My heart is already damaged and it is a life threatening thing, leaking valves can give out without warning, especially since I have documented proof that my valves went from 2 leaking very mildly to 3 leaking, 2 of which are very close to surgery, in just 2 years time. Thank each for your answer!