Question:
I AM IN DESPERATE NEED OF APPEAL ADVICE...

I have just been informed that Cigna has basically denied approval for the surgery. I need some help, I don't know what to do now!!! I called my pcp and his nurse called the medical director's board and they instructed her to talk w/ the administrative assistant, she had to leave a message for her to call back, she has done this twice w/in the week, still no calls.....I am about to pay Cobra to continue coverage w/ Cigna, but I'm thinking that maybe I should go ahead and take Aetan w/ my new job (but do I have to start all over w/ the pre-op tests?)!!!!???? I am soooo frustrated right now I am about to call it quits all together and not do this....but that is not what I want. Could someone please help me!!!??? thanks sooooo much.....    — reneagemini (posted on March 6, 2003)

March 6, 2003
What's really important to find out is why you were denied. Sometime's it's just because the doctor's office didn't send in the right codes. Find that out before you do anything. Also, make sure that you can continue with COBRA. I believe that it is not available if you quit to go to another job, especially if the new job offers health insurance.
   — garw

March 6, 2003
hi there :) im with the previous poster, find out why for sure youve been denied. it may be due to lack of information. my cousin was denied due to this but after the right info they needed was submitted she had been approved in 1 day. best of luck to you! :)
   — carrie M.

March 6, 2003
Tests are valid from the time element, not from who paid for them. They are still your results and you do not have to repeat them. It is advisable to get copies of everything that you have already had done. As long as you have continuous coverage of insurance without having a lapse of time, you should not be in a worse spot for having the procedure. Aetna picks up where the old one stops. If anything you could be better off. Cigna is in a bad fiscal position and I am not referring to Cigna that pays for managed care. At this point in time they will try to save anywhere they can when it comes to direct pays. I find it interesting, because if a patient has cancer, they would not deny a lifesaving surgery in order to save a buck. Obesity is a fat person's cancer and it does kill and it is relentless. For many it is a lifesaving procedure. In the January issue of the Cleveland Medical Journal there was an article that stated that the money that was saved on medical expensses paid for the surgery within three years time and the patient benefited from getting a better quality of life.
   — Sue A.

March 12, 2003
Aetna in some areas of the country is denying all precert requests, forcing everyone to appeal, self-pay, or forget it. I am in an insurance appeal hell with Aetna. This has been awful. Aetna changed their requirements on 1/17/03, so you should go to their website, search of obesity surgery and read Coverage policy Bulletin 0157 before you commit to aetna. Find out what you current appeal is all about, because Aetna will take a minimum of 6 months, so your current problem may be easier to fight.
   — Susan B.