Re: Help needed with appeal

December 9, 2000

Seadreamer, I am so very sorry, I feel your pain. I wish there were

something I could do. I will do some research on AMOS for you, I have

" sources " ;-) I do not know if I can find anything or not, but I will try.

Your Cigna sibling,

Sherri

Help needed with appeal

> Everyone:

>

> For those of you who haven't heard, I recieved a denial to my level

> one appeal on Thursday. This has been pretty devastating to say the

> least. The topper to all of this was a conversation via phone with

> the lady that handles the level two appeals that I thought was going

> to be a help in all of this. She informed me that with my policy

> having a written exclusion that they would not pay. When I told her

> that the exclusion was for code 278.00 obesity and not for 278.01

> morbid obesity she informed me that cigna did not differentiate

> between the two. She also stated that she had never heard of Cigna

> overturning a decision.

>

> What I need is:

> Someone who has Cigna HealthCare of North Carolina HMO/POS that has

> an exclusion for weight loss surgery that has been approved for

> weight loss surgery. This person must be willing for their case to

> be used by me as an example for the Administrative hearing for the

> level two appeal. Please note that it must be Cigna of NC and not

> other states. They and all insurance companies seem to differ from

> state to state.

>

> Thanks for any help you can give. I have posted this on the AMOS

> board also and I found one person's insurance post that listed all

> the above critieria. I have e-mailed her and invited her to join

> this list. Of course, she may already be a member and I not know it.

>

> seadreamer13

>

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