Question:
2nd denial, Is there any legal action I can take?

I have high blood pressure,sleep apnea,diabetes, bmi is 46. The only thing they need to approve is documentation of weight loss attemt in last 6 months (med supervised). I have been fighting with them since Jan.2003.    — Tammy T. (posted on October 8, 2003)

October 8, 2003
If I understand your post correctly, the insurance company is saying that you must have a six month supervised diet, and they do not have paperwork to document that you've done this. Then, if the documentation does exist, get it to them. If it doesn't exist, then start a six month supervised diet. If that's the only issue here, then I don't see that you have any legal recourse. They can make whatever reasonable requirements they want to, and nobody is going to tell them that you don't have to follow their rules. The rule is a reasonable one, and if that's all they're asking, I say do it, and stop delaying your approval by fighting it.
   — Vespa R.

October 8, 2003
PLEASE!!! Let me intervene here. I went through the same thing with Kaiser. I wasted 3 years of not wanting to do the stupid supervised diet. I could have done the damn diet, gotten my surgery and been at goal all in the time that I wasted fighting them. If you get a lawyer, it will cost you. There is no way that you will be done with any appeals or legal action in only 6 months. Don't waste money and time. Do the diet, jump start your metabolism and deal like the rest of us. (Didn't mean to sound cruel, you just have the opportunity to not go through what I went through - and I am kicking myself) -Erinn
   — Erinn D.

October 8, 2003
The insurance companies don't seem to budge on the supervised diet. If you haven't already asked your PCP to start documenting (all he has to do is put in medical records that he put you on a low fat diet and have you come in and get weighed monthly or at whatever interval your insurance requires). Like the previous posters stated, in the amount of time you spend fighting it, the money you'd pay in legal expenses (and still lose) you could have the supervised diet over with. Good Luck
   — Carolyn M.

October 8, 2003
You should now have a recourse with an outside review agency. Check your insurance and find out the what now? If you get an outside review your chances are better. Check out my profile-you'll see what happened with me! In the meantime-go get weighed in with your dr and start the supervised diet. You just might get approved from the review as I did and not have to do the six month but you're covered if you don't.
   — toni S.

October 8, 2003
Tammy, I would have spent my energy doing the 6 month diet from January on as you'd be done with that requirement and onto surgery. Start now and put your energies where it will produce results. Fighting is not getting you anywhere. Why is it a problem to comply with this if it is the ONLY way they will approve you? With sleep apnea you need to do whatever they want to get surgery. I was a 22/18 BiPAP before surgery and a 4 CPAP at 6 months out and released from any therapy at that point, so WLS truly can be a miracle cure for sleep apnea. Stop fighting and give in and in early 2004 you will have your surgery. If you have Aetna, they will now allow you to submit for approval before your 6 months is up, you just cannot have surgery before the 6 months. At least that's what I've seen posted in the past month or so.
   — zoedogcbr

October 8, 2003
Cigna WILL NOT give an inch on the supervised diet rule. You can appeal until the cows come home but it wont work. Like all the other said, stop fighting and give them what they want. I was denied twice too before I saw the light, gave in and did the diet. As soon as I finished that diet, I was approved with no problem. Good luck to you. ~Sidney~ Open RNT 10-23-02 down 120+ and counting
   — Siddy I.

October 9, 2003
Cigna will not waive the supervised dieting restriction, no matter what. It's best to go to your doctor now, get started now and then re-submit following documentation that this process has been completed. I did mine in 2002 but then Cigna only required as 12-week program in the last year. They changed their rule in November 2002.
   — Cathy S.

October 9, 2003
The only way that you could have legal recourse is if you could prove that they've approved someone else within your company with this same insurance "plan" since implementing this particular rule. That would be descrimination - maybe (there may be reasons for the approval of which you are unaware). If they are treating everyone the same and the rule is not considered barbaric (and while we may think this is, legally, it's not) then you really have little choice but to jump thru the hoops the require. Good luck!
   — [Deactivated Member]