Question:
I need ALL the help I can get...

Hi guys, here's a question I'd like to ask for someone I know. I've already had my surgery, but a relative of mine is hoping and planning to have it too. She is a diabetic and around 300 lbs. at 5'4", and is trying to get insurance approval for the surgery. She, like I do, has Cigna HMO and was just hit very hard with a denial letter. I can only imagine what that feels like. I can't speak for her, but I'm sure it must feel like her own death. It probably feels like the whole new life she's planned for herself is over and she'll never have it, though she wants it so badly. But you and I know that she just needs to get back in the saddle and try again. I KNOW she will succeed in the end; she just has it a little harder than I did. Guys and gals, any words of advice on dealing with insurance companies and any words of encouragement would be great and much needed. Thanks.    — mars.renee (posted on October 15, 2003)

October 15, 2003
Why was she denied? My advice would be to find out exactly why she was denied (does she need supervised diet, psych eval., etc.) and do whatever it takes to meet their requirements - that is assuming that her particular policy (even if your Cigna policy covered the surgery, that doesn't mean that her employer, unless it's the same as yours, hasn't chosen to exclude the surgery) covers the surgery. As long as she meets the criteria, they will eventually approve.
   — Carolyn M.

October 15, 2003
Please have her check out this group of people going through the same thing with Cigna, they support each other and help each other with appeals: http://groups.yahoo.com/group/Cignassqueakywheels/
   — Stephanie B.

October 15, 2003
THis might help. This is from Wlater Lindstrom at www.obesitylaw.com http://www.obesitylaw.com/insurancearticle.htm
   — snicklefritz

October 15, 2003
As stated by other posters, my advice would be to have her make sure she meets ALL of Cignas requirements to the letter. And speak to someone as to why EXACTLY she was denied. Insurance companies are notorious for being vague! Also, if in the end she is still denied by them, maybe she can switch insurance providers?? I have Aetna and was approved upon my very first application (but that was over two years ago, and a lot of companies have changed their policy regarding WLS). In the meantime, have her start saving the money! Lots of people pay for it themselves. I know it is very hard to save for a surgery like this, but people save all the time for cosmetic surgery. If she wants it that badly, nothing can stop her from having it, and sometimes that means paying for it herself.
   — Melissa C.

October 15, 2003
Original poster here - She had turned everything in that she was told she needed to. Two supervised diets, one psych evaluation, a couple letters from her doctors and an appointment with a Nutritionist. She even wrote them a letter herself. Every time she called, as with me, they told her it was "Pending" and that they needed more information from her surgeon. When she asked what they needed, they simply said that she had to ask the surgeon what the surgeon needed to send to the insurance company. Doesn't make sense to me, but hey. So anyway, I know they got all of the information that they needed but she still got denied. Anyone else out there get denied who got approved after appeal??
   — mars.renee