Question:
Cigna Plastic Surgery Coverage - Denied!!!

OK all my AMOS friends - I just received a call from my PS's office that my request for a panniculectomy was denied by insurance. I will get a letter in 3 or 4 days with the reason. The girls from PS's office said this is looked at as 'cosmetic' - I've lost 150+ pounds and get horrific rashes - really bad ones!! I sent pictures to CIGNA through my surgeon of these rashes - but unless I have a hernia or a growth of some type his office staff says its unlikely it'll get approved. I know I will appeal - but what next? I've always self-treated the rashes and actually have an appointment with my PCP for a letter of medical necessity. How can I get this approved? And - do you know if I can re-apply for this in a few more months after 'building a case' by visitng mt PCP for every rash and backache?? Help Please!!! Thanks    — Pamela P. (posted on July 17, 2002)

July 17, 2002
i have cigna and before i had ever heard of gastric bypass i went to a plastic surgeon to see about breast reduction. i was told then as i have been told now that i would be covered as long as they received a letter of med necessity from the doc. that just seems to hold true for my experience with cigna. other people with my husband's company have told me the same thing. any type of bill that i get that is related to my gastric bypass will always have to be accompanied by a letter of med necessity.
   — nikki R.

July 17, 2002
I have CIGNA PPO (in NC)as my secondary insurance provider, and they immediately approved my panniculectomy and armlift after receiving a letter of medical necessity and accompanying photographs from my plastic surgeon. They were a pleasure to work with in my case. Every insurance provider has an appeals process. Call CIGNA and speak to your case manager. Find out what they require in their appeals process and follow through....don't give up without a decent fight :-) I had to appeal a denial for this surgery by my primary provider, and was approved one week after the appeal was filed. Good luck!
   — Diana T.