Question:
Has anyone had their insurance send their claim off to an independent reviewer?

What does this mean and are my chances good or bad? I don't have any really bad comorbities and I have a BMI of 41 and am 115 lbs overwieght. Any help would be so completely helpful....if you would like email me at [email protected]. Thanks    — hawk4life (posted on December 13, 2001)

December 15, 2001
Stacy, I have Cigna HMO. When my first surgeon sent my pre det. letter to Cigna they sent to to an independent review board. Why? Because I have an exclusion in my policy that prohibits WLS unless "medically ness." The board had to review all my information and history to decide if my surgery met those requirements. They denied my request for the Adjustable Vertical Banding, stating that it was inferior to the RNY and that it was too new and experimental (it was just approved by the FDA). However, they stated that they would approve the RNY. So now I'm starting over with a new surgeon and a new WLS. I hope that helps.
   — Shana C.