Cigna Select, PPO - Austin, TX Denial, 8/13/04

I didn't even know this forum existed so here goes my plight: Okay, I need help. Please let me know some suggestions on how to appeal my recent decision. I was afraid that this would happen as I do not really have anything wrong with me other than being overweight, at least medically speaking. I weigh over 300 pounds, have acid reflux occasionally, some swelling, and can get out of breath climbing stairs, etc. I have horrible back pain, but nothing that is medically documented. This is it for the "medical" piece. Now, mental and quality of life are a different story. I have eight children, six have moved out and two ages 12 and 3 are at home. I do not participate in any of their school functions because of my weight (I really can't fit in a school bus seat for field trips). My job recently demoted me from controller to senior staff accountant because "they were looking for a "different" type of person to perform the roll". They did not reduce my pay and I strongly suspect this was due to my weight but I cannot prove this. I am not able to stand for long periods of time which is required for my job in regards to inventory, making copies, and various other functions. I mainly wear black, ocasionally denim or dark blue. I do not go to theme parks, public pools, etc. I hate to go to social functions because I do not know if I will fit in other people's chairs, (I do not fit in my mother's patio furniture). I do not go to the doctor when I am sick because I figure they will say it is because of the weight everytime. I barely fit into the seat at the movies. I am afraid that I smell all the time and am obsessed with preventative action. I sleep in my recliner because of my back problems. I'm sure that most of you know the rest of the story. Now I am ready to fight back. Please give me some suggestions as to what to do next that will be the most effective. Should I just cut to the chase and get an attorney??? Thanks to all of your support, I am very happy that I found this website. Dawn ([email protected])

Dawn, It was almost as if you were writing this post for me. So many similarities exist here. You will find on my profile that I was also denied by Anthem BCBS Access of KY. I am considering hiring Gary at www.obesitylawyers.com. I am so used to failure and losing out on things that I am not sure if I would be successful if I did. I do know that I will appeal regardless if I seek legal assistance. I too was recently demoted from my job. Since I was demoted, I have been traveling. Now that I am traveling, I have to fly and sometimes can not fasten the seatbelt on the airplanes. Dragging through the airport with all of my luggage is exhausting causing me to feel faint. I can not financially afford to start over in my career. When I was demoted, I also received a $2 cut in pay, and I can not move into any other position within the company for one year. ... back to your post, I would gather all the facts and research making sure that when you do appeal that you have supporting evidence. I have also read that when you write your appeal letter be firm and factual instead of pleading for their help. Word is, they take advantage of the weak. If we stand firm and let them know that we are being discriminated against, I believe we stand more of a chance. I wish you look and hope that I do not see you here too much longer - in other words, I hope I see a big fat APPROVAL POSTING for you! Thanks, Beth

Dawn, I acidentally erased your email. Is yours a written exclusion? and how is it worded?

Hi Dawn, No need to crack open the wallet for an attorney just yet. Cigna requires a 26 week physician supervised diet with monthly weigh ins. If you do this, and your BMI is over 40, you should have no problem being approved. Also, check out the Yahoo Group - Cigna Squeaky Wheels. It's a group just for people like you fighting Cigna for WLS. I know what you mean about staying away from the doctor, because they blame everything on your weight. Now that I've lost 130 pounds, I can tell you that in my case, they were right on the money. Take care, Roberta

Dawn, I think Roberta said it very well, No need to crack open the wallet. Cigna is tough, you just need to be tougher.

read what I just posted about Cigna........then I suggest you save yourself a whole lot of pain and time and waste.....save your money and go to Mexico...... Under $10,000 for both RNY or lap banding....check out the doctors south of the border in communities. And read the stories about people who have done it......I know, trust me......yuck, Mexico, but quite a few people are heading that way now... it is just a suggestion.......and have it done why you are still able to work, that was my fear, that I would wait and then couldnt work to afford it.