Question:
What is the best way to appeal with Cigna HMO?

I have provided Cigna with everything they required and they still denied me. Stated I did not prove I had been overweight for the last 2 years. I had my info from when I joined WW on 5-1-01. Have any of you heard of a "peer to peer revue"?    — Karen T. (posted on July 9, 2003)

July 9, 2003
I'm not sure how to appeal... what grounds did they deny your surgery? A peer review is simply a bunch of "medical professionals" (usually a couple of nurses) getting together, looking at your records and deciding if you are sick enough to warrent surgery, as if they have ever seen you or treated you. That's basically it. It's wrong because they are not the doctors treating you and have never examined you but insurance companies routinely use this tactic to justify denying expensive procedures.
   — Happy I.

July 9, 2003
Peer to Peer review is just that the doctor who reviews your case should be a bariatric surgeon, or whoever is doing your surgery the reviewing doc should be the same. If you have the WW info since 01, I would call and talk directly to them (the nurse who is handling your case) to ask if they actualy recieved this info and was it sent to the advisor (doctor) that was doing the review.
   — ZZ S.

July 10, 2003
I was not sure how to handle an appeal to my insurance co. MMO Medical Mutual of Ohio. At the information meeting I attended with Dr.Kligman in Toledo, Ohio, he had told us not to use up all of your appeals before considering a lawyer. He gave the name of Walter Lindstrom, Who is a Obesity Law Lawyer in San Diego, Cal. His email is [email protected] and the web site is www.Obesitylaw.com you can get all the information you need and they will answer any questions. I started my search and decided to hire Mr. Lindstrom and his wife the early part of January, by the end of March my appeal had been over turned. I hope this will help I was at the end of my ropes and this was an answer to my prayer's.. Good Luck Danise
   — Danise G.

July 13, 2003
I asked my primary doctor for copies of a few pages from my chart that included the date, weight, blood pressure, etc. I highlighted those things and it was proof of being overweight for many years.
   — Chris S.