Question:
Appeal denied again! Now what?

Is it possible to fight this on my own and win? I would hate to have to pay $1100 to an attorney, then lose, then have to self pay. My original denial was because I didn't have 2-6month weight loss programs, BUT I had an 18 month membership to curves, and NUMEROUS dr visits with prescriptions for my good ole pal, ADAPEX. I lose weight great on adapex, then as soon as I get off of it, I can gain 50 lbs a month! SO anyways, I digress... What should I do? My hubby is in the hospital, although he is super healthy he got a cut on his foot, and now he is in their for IV antibiotics because nothing the dr prescribed worked. I have 4 kids, I am a student, He will be back at work in a week I am sure, but in the mean time, hiring an attorney is out. How long does this 3rd appeal take? I must sound incredibly selfish right now... me me me... I have been at the hospital all day. I am not really the witch I sound like...    — kjonhjk (posted on May 6, 2003)

May 6, 2003
Joy, I don't have Cigna, but have Aetna. I did hire an attorny when I was denied. I still ended up being denied two more times for a total of three times. It ended up going to an external review, and was overturned. Find out from your insurance company all the level of appeals you can go, and keep fighting. You don't need an attorny to go through all your level of appeals, but it can make it easier. Robin
   — Robin T.

May 6, 2003
I have CIGNA as well, but a POS plan. I'm not positive, but I don't think an attorney would do you much good for your HMO plan. A review board may be your best chance. Remember to bring all the ammo you can to the table. Will your primary physician write a letter on your behalf? Good luck to you! Kimberly
   — Kimberly S.

May 6, 2003
I still have some resources I haven't used. The Dr. who prescribed the pills isn't my current PCP but he will write a letter if I go PAY to see him ( he is out of network) and my PCP's daughter is one of my daughters best friends, although he has never monitored my dieting personally he has seen my mom (super morbid obese) for years and he is more of a family friend than a doctor in that our kids do sleep overs. He did write a letter but I am not sure how good it was. Would it be out of line to ask him to exagerate?? I am desperate. Also I talked to a man in some federal office (duh) I have his number and he said since my hubbys insurance is self-insured he can help me get them to approve it. I got his number through the insurance commissioners office and this man was over zealous to say the least. He said " THEY CANNOT DENY YOU a MEDICALLY NECCESARY PROCEDURE withouth an exclusion...." maybe maybe... also anyone who wants to be in our cigna e-mail club, let me know, we're trading secrets...
   — kjonhjk

May 6, 2003
I would start a supervised weight loss program. They mean supervised by a DR not Jenny Craig or Weight Wacthers. Insurance will only take the word of a DR. Good Lux
   — Robert L.

May 7, 2003
I am goin thru the same thing. My PCP has written 2 letters that verify everything but because he didn't write it in my dr visits the insurance co says it hasn't been documented. I also included a 3 yr history of diets. I don't know what I'm going to do if I don't get some help with this?
   — Marlene L.

May 8, 2003
Walter Lindstrom helped me with my appeal and I did not had to pay much, it was worth it.
   — Gilmaris M.