Cigna "duration of more than five year"???

Ugh!  I've been denied TWICE from Cigna.  "The obesity problem must have a duration of more
 
than five years.  The documentation submitted indicates that while your current BMI is greater
 
than 40, it has ranged between 30 and 40 over the past 5 years.  Therefore this request cannot
 
be approved, as the documentation does not support that you have been consistently obese

over the time period required by your benefit plan."

Ummm............ I thought having a BMI of 30 or greater IS obese?!  It has fluctuated because I have been trying on my OWN to lose the weight before turning to the Band. 

Has anybody been through this?  Any suggestions?  I'm about ready to give up.  I asked for their requirements many times and NOWHERE does it say the mentioned above, only in their letters to me.

Any help or suggestions would be greatly appreciated.

Thank you.

 Becky.....Do you have any co-morbidity's???   Usually if you have at least one of them your insurance will approve you for WLS.    Ya know....it just doesn't make sense to me why they won't cover WLS.   Don't they have the common sense to know that when you get to a healthy weight most of your health problems disappear !!!!   UGH !!!!  Ridiculous !!!   You might want to call the insurance co. and talk with whoever is handling your case and explain to them that the reason that your BMI did stay greater than 40 was because you were trying to diet and get it down on your own but were unsuccessful.    Just a thought.   Good luck to you.


Hugs and blessings ~~~ Vivian

I have arthritis in both knees, and  GERD (gastroespohageal reflux disease).  Does that count??  I have all the Doctors recommending me to have the band, the Gyno, PCP, Orthopedic, Nutritionist, Psychologist. 
I did let the insurance company know that I would diet lose the weight then gain it all back and then some.  I have sent letters and had two appeals.  The first one was denied right away with no explanation, just a generic letter.  The second denial was after a phone conference with Cigna.   I have done everything they have asked, read through their requirements that they sent to me.  This is so very frustrating.
thank you for responding.

I have also mentioned I have had weight problems since the birth of my first son 10 years ago.  In my letter to them I also mentioned that I am fatigued all the time, shortness of breath on any exertion, and have skin rashes in the folds of the skin.  don't understand the twice denial??

Becky,

My first advice - DO NOT ATTEMPT ANOTHER APPEAL until you speak to a bariatric lawyer. In NJ (and I unsure if it's NATIONWIDE) if an insurance company denies you 3 times - then you're OUT OF LUCK and can never apply again (unless you change insurance companies).

Speak to your Doctor to see if they know of a law firm that deals with this. If not, go to your OH State Web page and see if anyone there knows. Also, you may want to reach out to a Realize rep in your State to see if they can recommend a lawyer.

More advice - DON'T GIVE UP!! That's what they want. Don't give them the satisfaction. Keep on plugging along, and know we're here for you.