Question:
Has anyone been denied for 26 weeks of supervised diets? appealed and won?

I have Cigna PPO new hampshire and just found out that I am being denied because I do not have a 26 week supervised diet by the same doctor. Has anyone had this denial and then appealed it and won? How about hiring an attorney? I so need this surgery and want it. I cannot afford self pay. Please help with any suggestions or sample of appeal letters for this same situation. Thanks    — Natalie J. (posted on August 8, 2003)

August 8, 2003
I have Cigna PPO and was denied for the same reason. The surgeon appealed along with me and I won. I wrote them a letter giving a list of all the attempt at weight loss. Explaned that I have two small children and need to be around for them. I gave them all me medical complications because of obesity. I even sent them pictures of my children. You need to appeal. Make them feel ashame for denying you. I think they automatically deny hoping you will go away. Good Luck.
   — shbama

August 9, 2003
I went through the same thing. There are a few things you can do... Make sure that EVERYTHING you have done reguardless if it was "weight" related or not is documented by your PCP and a copy of it and send it in. Next, there is/was a letter on this site that you can use as a cover letter (if you can't find it, let me know I will send you the one I used). I may have over embelished a little on it, but I was tring to get a point across. After you have sent your appeal in it will take 30 days, don't bother calling before that you will just get the same run around. Now, I was approved on my appeal so I'm not sure about hiring an attorney or anything, but I do know that this site has a TON of very useful information about it. Good Luck! Tom
   — Thomas E.

August 9, 2003
I too was denied for that reason. I have Cigna POS of Illinois. I sent in my appeal letter and I am waiting to hear back from them. In the mean time there is a group on yahoo called [email protected] and everyone in the group has dealt with cigna. It's very informational.
   — Sherri M.

August 9, 2003
i had cigna ppo of colorado, i resently changed to pacificare because cigna keeps changing there requirments for this surgery. fist they said i had to have a 26 week dr sup. diet, then they said i needed two 6 month dr sup. diets with two different dr's. i was told by someone else who had cigna that they will just keep finding any little things or keep changing things to deny. I was also told that i need these to be failed diets in order for them to approve, but someone else i know was denied because she didn't lose enough weight on her diets. "Didn't try hard enough" is what they told her. So as soon as i had the chance (husband got a new job) i got on a different insurance. I pray cigna works out for you, but if you have a chance to change insurance companies, do it. God bless!
   — Dinell H.