CIGNA HELP NEEDED IN DE!!!!!!

Hi OH members: I live in Delaware. I was supposed to have surgery on July 20th, but one day before surgery I was denied by CIGNA. As mad about this as I am the bigger problem is that there is only one group of doctors in DE who do WLS surgery and while the doctors are excellent the office staff stinks!!!! The first time that I was denied some of the problems was that paper work was not sent on time and my pulmonary Dr. clearance was never sent. I appealed this decision, sent an appeal letter and copies of all missing paper work, a letter of necessity from my PCP and was again denied. This time CIGNA is saying that I needed to be in a 6 month Dr. directed weight program (they also said this the last denial) which is the reason for the letter of necessity from the PCP and copies of office notes the doctor made from the last two years (I'm a diabetic) They also said that the decision was made because it was not cause effective and that there could be a least expensive alternative. I am diabetic and while seeing all the pre-surgery doctors it was found that I have sleep apnea and GERDS. I put a survey on the DE message board to see what patients had CIGNA and if CIGNA paid for their surgery. Not one person responded. CIGNA has said that I can appeal this again, but I feel this is a paper chase and they are hoping I will go away. In the mean time the Dr. office has offered me no help at all!!! I'm now looking to see what help I can get from my husbands union (he works for Getty/Lukoil) to see if they have a lawyer to help me. PLEASE!!!! READ this long winded and desperate appeal for help!!! If anyone out there had this surgery with CIGNA what did you do to get approved? Desperately Seeking Help In DE! Rosemary

You had surgery scheduled WITHOUT an approval in hand???? I'm confused.... I had CIGNA in IL and they not only denied me until my appeals were exhausted, they did everything possible to confuse matters and delay everything. I worked with attorney Payam Shayani and they denied his appeal document. He told me they were one of the hardest to deal with. I've been reading good things about Gary Viscio. You might want to contact him. I finally got approved when I was dropped by CIGNA and qualified for BCBS coverage as administered by the state of Illinois. I got nowhere with CIGNA.

Hi Rosemary..I'm so sorry to hear what your going through. Denied 1 day before surgery? Oh god, I could'nt imagine. I was just approved by Cigna on Monday after they finally recieved my paperwork (after 5 tries to get it in their system). It only took 2 days for my approval. I remember when I started my journey (Nov'04) I did alot of research about Cigna and I found this 1 post by someone in Yahoo Groups that said that in order for approval you MUST play the game that Cigna likes to play. She mentioned that you HAVE to do the 6 month diet. So I did. I sent in the notes from my PCP, a letter from my nutrionist, my psych exam, my medical records for the past 14 years and notes from a health education course I took while doing the 6 month diet. That's it. No journals, no letters from every doctor under the sun - just what they require and I was approved. I was told by someone at Cigna that there is no way they will approve you without the 6 month diet but then again, I've seen posts from people that were approved without it. So I guess it's a combination of luck and the mood the examiner reviewing your claim is in. I hate to say it that way but it's the truth. Either way, If I were you, I would consider doing the 6 month diet and then resubmit otherwise, I would get Gary's firm on the case. Good luck to you!

Rosemary, I'm a former Delawarean. I didn't know anyone did WLS in Delaware. I have lived in Florida for 2-1/2 years now, but miss Delaware bunches. My husband contacted one of the best surgeons in Florida for WLS, but his staff was, by far, the worst staff I have EVER dealt with. They are horrible. No call backs, answering machines, you give them the paperwork, and they do nothing but fax it. You have to do everything else. Sounds to me like you need to switch doctors. What about Philadelphia? I'm sure there are more doctors up there to pick from. I'm on my second appeal with AETNA, so I'll be thinking of you. I was turned down for the same reason as you, although I had seven months of Weigh****chers. The kicker is, they approved my husband, and he had the same documentation that I did. Liz

Liz, have you looked into the bariatrics program at Halifax Medical Center in Daytona? They added a whole section at the hospital and the staff is excellent! I'm biased, my mom works there! Good luck to everybody trying to get this surgery.....

Hi Liz: Thank you for responding. There is only one group of doctors in DE doing WLS surgery. There was a Dr. Miller downstate who either decided not to do the surgery anymore or was put out of business for some reason. Dr. Igrau is the main surgeon with this practice and he comes highly recommented. He was the one that was supposed to do the surgery. The problem is that while he is great his staff is like the office you mentioned about your husband. They were part of the reason that I was denied by the insurance co. in the first place. They sent paper work in late (one week before surgery) and did not send one of the clearances for the pulmenary dr. and since I was denied they quickly put someone else in my place for surgery and I have not heard from them since. I had to write my own appeal letter and fax it to the insurance along with copies of the missing paper work. I thought about looking into going to another state, but one day when I was on this web site I saw an memoral page and clicked on it and this stopped me in my tracks! It had a really long list of people who have died from this surgery and the state where they were from. I clicked on several from PA and found two many people that had died at the University Of Penn. hospital for my comfort. I always thought they were a "Top Notch" hospital like John Hopkins in Baltimore. So I will stick with Dr. Irgau even if I have to do all the work to finally get approved. I have not endeared myself to his staff anyway, because I reported this to the Insurance Commissioner's office of DE and wrote a letter to Dr. Irgau complaining about his staff. I fear that when I get (or if I get)! approval that his staff will all be in the operating room to take care of me!!!! I am now looking at my options legally and hopefully get some where by this method. Good Luck with your fight and never give up!!!! Rosemary