Question:
DENIED!? WHAT DO I DO NOW?!?

AFTER ALL THIS TIME......I CALLED THE INSURANCE COMPANY TODAY AND THEY SAID I WAS DENIED. WHAT DO I DO NOW, WHERE DO I GO FROM HERE? THE NURSE AT THE DOCTORS OFFICE AND ME DONT HAVE A REAL GOOD RELATIONSHIP SO I'D RATHER NOT CALL HER FOR ADVICE, YOU GUYS ARE SO MUCH NICER. I CANT BELIEVE IT (WELL, I CAN BUT.......) DO I DO AN APPEAL???HOW DO I DO THAT?? THX GUYS!    — Karen W. (posted on October 17, 2002)

October 17, 2002
The first thing to do is find out WHY you were denied. Was it a policy exclusion, was something missing when your surgeon submitted stuff or what? Once you have that info you can build your case for an appeal. Hope this helps..dont give up, many insurers figure we will give up before they do. But get your info and compile your facts. remember "knowledge is power". Good Luck Keniki
   — Keniki B.

October 17, 2002
Call Cigna and ask for a letter detailing their requirements and the reason you were denied. Then get with your doctor and make a plan for combatting each reason. Then resubmit as an appeal. From looking at your profile your BMI is a little bit lower than Cigna's base requirement. That might be it. I think they require a BMI of 40 or more, but with CIGNA, who knows sometimes. They also require 12 weeks of physician supervised dieting within the last 12 months. If you don't have that, get your doctor to start it now. It need be nothing more than your doctor handing you a diet and checking your weight once a month for 3 months. But all this stuff needs to be documented in your records. Also make sure all your co-morbidities are documented in your doctor's notes and then file your appeal. That means you get all these notes together and write a letter to Cigna requesting an appeal. But I wouldn't do it until I had all this done.
   — Cathy S.

October 18, 2002
I too was denied the first time but not thru Cigna. I wrote up a 15 page appeal letter only to find out that they would only accept clinical information from physicians on which to base an appeal decision. I think I still may have my letter let me know if you'd like a copy, I can fax it to you and you can have your pcp read and make their own version. It may help if they don't have to do the research themselves. I also may have an electronic copy you can email to your doctor, they can add/remove and then sign. Let me know at [email protected]. Whatever you do don't give up.
   — Sara A.

October 22, 2002
Find out why you were denied and what their requirements are. Insurance companies will sometimes deny you and try to get away with not telling you specifics as to why, but request that in writing and then go from there. If necessary I would hire a lawyer. Obesitylaw.com is great and got me approved after fighting with my insurance for 4 months to get approved. The cost was under $400 and worth every cent. Don't give up Dell Hunt RNY 3/4/2002. Now almost 8 months post op down 124 lbs.
   — Dell H.