X-post Appeal

Has anyone ever appealed to Cigna and won? I have a Realize Band and had to have an emergency unfill in December. Since then I have had a lot of acid and heartburn. My doctor sent me over for an upper GI and my band is in perfect position. I haven't lost ANY weight since April of 2011. The last few months have been fill to be unfilled the following month. This is frustration, I am hoping to revise to the sleeve.

I would appreciate any help offered.

Thanks

Andrea

Try posting on the failed bands board. I can't give you the link because I wasn't allowed to join and it is a private group.

I don't think there's one clear answer to that question because everyone's medical history is unique and Cigna's decision about a revision surgery for you will depend on the terms of your particular Cigna policy, which could be quite different from the Cigna policies held by other people.

Has your surgeon submitted a revision procedure for you to Cigna and you've been denied, or are you worrying that they might deny you in the future? Can your surgeon's insurance coordinator check into it for you? You could call Cigna yourself and ask them, but they might want some procedure codes.

My insurance company (Anthem) approved my revision last year without a murmur, which was interesting because they had originally denied my band surgery (in 2007). In part, I think their revision approval was due to my surgeon's insurance coordinator providing enough documentation to prove that my revision was medically necessary. I have a friend who wants to revise to RNY for reasons similar to yours, and her insurance denied it because her policy has a one-WLS-per-lifetime clause.

Good luck!

Try posting on the Insurance Forum.  You have members there that have successful appeals and can share with you what they did.

Regards,

Member Services

Thank you Kate! 

Jean--I received the letter from Cigna a few days ago denying me because my band has nothing "mechanically wrong with it".  The past few months have been terrible.  I never left the house without a bag, everything I ate was sure to make its way back.  I would be loose, get a fill, then I would be fine for a few weeks.  Then out of the blue I would be tight.  So my doctor unfilled me completely in December.  He suggested I started thinking about a revision.  I also have terrible acid reflux going on, which I haven't had since my surgery.  I didn't miss the acid at all!!

Thank you again for your help!

Andrea