Question:
CIGNA rescinded my approval! Now what?

5/14/04 HELP ME! I just found out last night that CIGNA rescinded my approval! I've already had all of the pre-op tests, I've made arrangements at work, and my husband has rearranged his schedule to be off during my first two weeks. I only have a week and a half until my original surgery date. I sent a letter of appeal along with my documented weight loss attempts (that's what they say was missing). Problem is, I have 4 months with one program (Dr. assisted Phentermine and Xenical) and another program for 4 months (Dr. supervised w/nutritionist). That's 8 months all together, but they want at least 6 months on one program! What do I do if they deny my appeal??    — Roberta M. (posted on May 14, 2004)

May 14, 2004
I am a firm believer that once you are approved, and you've relied on that approval, the Insurance Company can't rescind and force you to go through the appeals process which is very heavily weighted in their favor. I would suggest getting a local lawyer involved who might be able to argue with their legal staff that CIGNA has a contract with you and that they are breaching that contract by "rescinding" approval. Good luck. I have had nothing but trouble in my dealings with CIGNA-- quite frankly, I found that there seems to exist with CIGNA a corporate culture in which lying to and misleading the insureds is encouraged.
   — SteveColarossi

May 14, 2004
I agree with Steve, get an attorney asap. Cigna is trying to see what they can get away with. Good luck.
   — bubbleboo K.

May 14, 2004
Go to this website www.obesitylaw.com or call Kelly Brown (attorney) at (619) 656-5251. At got this info at a support group meetingm hoping I wouldn't have to use it. I ws denied my first time. I called Kelly Brown and she gave me excellent advice, told me what to do, what letters to write, what steps to take. We talked in great length and she told me she didn't feel I would need to "hire" her, just try what she suggested and if for some reason I couldn't overturn my appeal, she said to give her a call back and then we could talk about taking the next step. I did everything she told me and my surgery is Monday! I do not beleive legally your insurance can approve and then deny...call her today! You will probably have to leave a message, trust me when I tell you she will call you back. The law firm is located in California and I live in Connecticut and there were no issues. Check out their website, I am sure they can help you. I beleive it says they have an 85% - 90% rate of getting denials turned over. The girl I got this info from also followed their advice and had her denial reversed Good Luck! Sherry
   — sac287

May 14, 2004
I would get in touch with Gary the lawyer on the yahoo cignasqueakywheels...call him..
   — jellyin

May 14, 2004
That is exactly what Cigna did to my husband. He was totally approved with them saying that it was medically necessary for him to have the surgery and then then turned around 2 months later and denied him and they was no way to budge them. Fortunately, my insurance covered him fully for the surgery. Cigna insists with having those doctor supervised diet trys. Good luck.
   — ChristineB

May 15, 2004
If they sent you an approval letter that states it is a "medically necessity" Call the insurance commission and report that. Good Luck!
   — ZZ S.

May 15, 2004
Roberta, most doctors likes to switch meds of methods of weight-lose after 3 months if they find those methods ineffective and that is what your Primary doctor should state in his or her letters. Your surgeon should be the only one sending information to the insurance company - and he/she should know how to blend your attempts as an continuous effort - GOOD LUCK.
   — Anna M.