DENIED and really Devastated, to say the least!!

fordrachel
on 8/18/10 2:22 am - memphis, TN
 O.k... i am in tears as i type this, just got off the phone with Cigna Insurance, and i was told that my request for WLS has been DENIED!!!  Says MEDICAL NECESSITY HAS NOT BEEN MET??? I asked him to go into detail and explain, he just said the letter is in the mail...  I completed EVERYTHING that was asked of me!!!  6 months doctor monitor/approved diet, Nutritionist eval, Psych eval, BMI of 39 with Sleep Apnea, GERD, and lower back pain.  I am ready to start my APPEAL PROCESS, because not only do I want this, but I NEED THIS!!!  I guess they prefer you to be SUPER MORBID OBESE and health already at the END STAGES to be approved???  I am Hurt, and Devastated, so I'm taking the rest of the day off from work, because I just cant work right now, with all this on my mind.   Any help, or words of wisdom,  is really NEEDED right now... 

              
Hello... My name is Rachel, I am 5 feet tall.... sign in BMI 40.4...  pleased to meet you!!!
Starting BMI between 35 and 40ish? 
Join us on the Lightweights Board!
MajorMom
on 8/18/10 2:29 am - VA
Keep fighting. Don't give up! ((hugs))

--gina

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
                                 ******GOAL*******

Starting BMI between 35 and 40ish? 
Join us on the
Lightweights Board!
DS on Aug 9, 2007 with Dr. Hazem Elariny

Jody ***
on 8/18/10 2:41 am - Brighton, MI
RNY on 10/21/08 with
OMG - after you've gone through all that??  Don't give up - keep fighting and appealing.  It will happen... you may need to get your Dr's office involved.  I've heard if they write a letter stating your medical necessity that can work.

HW-218/SW-208/CW-126/ Lowest Weight-121/Goal-125 - hit 8/23/09/Height-5'3"

Regain 30 lbs from 2012 to 2016 - got back on track and lost it.  Took 8 months. 
90+/- pounds lost      
BMI - 24 or so
Starting BMI between 35 and 40ish? 
Join us on the Lightweights Board!

Jane W.
on 8/18/10 2:41 am - Southaven, MS
Rachael, I am SO SORRY to hear this...I really feel bad for you.  I am glad you are going to appeal this.  If the magic BMI for your insurance co is 40, gain a few lbs.  Good luck with appeals process.
5'6"    
lerkhart
on 8/18/10 2:47 am
Rachel,
Appeal, but wait for the denial letter and see what the reason is.  It may be something as simple as something not being turned in. 

I would get your surgeon's office involved to help you with this because they usually have so much more experience with the insurance companies. 
Did you call them?  They may already know the reason you were denied.

Did you get a written list of what was required to be approved?  If not, I would asked them for that in writing.

Good luck and keep us posted.
Linda
14.5 lost pre-surgery  5'1 1/2"                                      LW-Apple-Gold-Small.jpg image by PlicketyCat
fordrachel
on 8/18/10 3:01 am - memphis, TN
 Thanks everyone!!!  and Linda, yes, i got a list of EVERYTHING they needed, and I completed them with flying colors, and YES I even gained a few pounds... I have a feeling I will pack on a couple more pounds with the depression coming from this DENIAL...  it aint over until this PHAT LADY  sings, and I AINT SINGING YET!!!!    

              
Hello... My name is Rachel, I am 5 feet tall.... sign in BMI 40.4...  pleased to meet you!!!
Starting BMI between 35 and 40ish? 
Join us on the Lightweights Board!
Liaazul
on 8/18/10 3:11 am - MD
Do not give up, babeeeeeeeee! Fight! Once you get the letter of denial, address each point they are making against you with support documentation from your doctors.

My mom was denied at first and with her PCP support, she was able to overturn the denial on the first appeal. Fight!

There is an insurance forum on OH that has a lot of knowledgeable people. You should post there once you get your letter of denial.

We'll be swinging lizards for you!

Height 5'5" -- HW 273/SW 269/CW159/1st Goal 169(Achieved!)/2nd Goal 150 (Normal BMI)  LW-Apple-Gold-Small.jpg image by PlicketyCat
Starting BMI between 35 and 40ish? Join us on the Lightweights Board!
  
       
Shannon D.
on 8/18/10 3:18 am
Appeal, appeal, appeal...lots of people get denied, but appeal and win! You are worth the fight!
   
  5'0"   HW-214   SW-186  GW-115  CW-96-99 
  LW-Apple-Gold-Small.jpg image by PlicketyCat
    
Happy_Camper
on 8/18/10 4:56 am
I was were you are a few months ago.  Denied TWICE!!!  cried for weeks until it all got straightened out.  Wait until you get the actual letter in the mail for the explaination.   Perhaps its something your surgeon can go to bat for you .... a peer to peer review.  Just dont give up!  Keep fighting!!  Good luck!  Cindy

Surgery March 2, 2010 -  5' 9"  -   HW 278 /  SW 260 /  CW 139 / GW 150

LW-Apple-Gold-Small.jpg image by PlicketyCat                         

valleyfree
on 8/18/10 6:19 am - OR
Keep trying - don't give up! Your surgery center wants the money -- make them help you!
HW 247/SW 232/CW 135/GW 140 Height 5'4"  Age 43 A BIT BELOW GOAL

        
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