Question:
Help! I'm in 2nd level appeal w/Cigna & have a telephone conference call w/Committee

Hi...I have been denied by Cigna several times within the past 2 years. The first time was no co-morbidities...since then I have been diagnosed with Sleep Apnea, Arthritis (knees), and Acid Reflux so I applied again...and was denied for weight loss history. My surgeon's office says they sent everything that Cigna has been asking for and they can't see them coming back with a denial again. This is my 2nd level appeal and they said I can be included in the conference call with the Appeals Committee. My question is...what kind of info should I have prepared? What are they going to ask/talk about? I just want to be sure that I have all the info that I am going to need...but I'm not sure exactly what that is. Any help is GREATLY appreciated. Thanks!!    — Giovanna G. (posted on August 5, 2004)

August 5, 2004
Do you have a 26-week physician supervised diet history that has occurred in the past year? and one further back? Cigna will probably deny you if you haven't documented that. Be sure to prepare some statements of how your weight is affecting your "quality of life" and "quality of work". That will help too. Stay really positive, but firm with them. Cigna is a bear.
   — Cathy S.

August 6, 2004
I am also dealing with Cigna. I have to finish my psych eval and nutrition eval before sumitting for denial... I mean approval, but am prepared for a fight! I have found alot of great information from http://health.groups.yahoo.com/group/Cignassqueakywheels/. I would reccomend checking that group out, they can also give names of people to help with the appeals.
   — Carmen S.

August 7, 2004
Make sure you talk about "medical necessity" reasons and use that term. Talk about your health issues mainly and if you have parents or siblings that have major heart or other diseases that you would be trying to prevent in the future. You can talk about knee replacements, physical therapy, GERD meds etc..(which are expensive) talking $$ to them is good.
   — ZZ S.

August 8, 2004
Read your post re: committee conference call. If at all possible, GO TO the meeting IN PERSON. They need to SEE that you are a PERSON, not a sheet of paper. Trust me on this, I used to work for an HMO and participated on grievance committes. The participants are more likely to say yes when they are looking at you sitting a few feet away from them. If not, be sure to tell them that YOUR LIFE DEPENDS on THEIR DECISION, and you need them to approve the procedure ASAP. Good luck, Diane N www.WeightlossSurgery.ws
   — DianeN

August 14, 2004
Hi Everyone...Just wanted to give an update. On August 5th, I called Cigna to tell them I would be on the call. (The option of going in person wasn't given to me, plus it is in North Carolina so I probably wouldn't have been able to go anyway). They told me the call was cancelled because the appeal should have been sent to Intracorp, instead of Cigna directly. Funny how they realized this about 3 hours AFTER I called to tell them I would be on the call. They received the appeal on July 19th...and didn't realize it until the 5th of August that it should not have gone directly to them???? Don't understand that. So the wait continues..........
   — Giovanna G.