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