Guest guest Posted June 25, 2000 Report Share Posted June 25, 2000 > KRIS! > > WOW 22lbs. WoooHoooo That is fantastic!!! Good for you winning that appeal! > Did you get denied because of an exclusion? or was it just BS?? Keep us > posted! margie SC Dear Margie, Thanks a bunch. CIGNA denied me because I didn't have enough documented " physician supervised weight loss attempts. " I am 40 years old and been overweight my entire adult life. While I never went to Craig type places -- I did everything else, including being placed on an amphetamine for weight loss while I was a teenager. My opinion was that CIGNA could find nothing else to deny me on because I really did qualify (BMI 38 with comorbidities) under their requirements. So, I think that 'BS' sums it up pretty well. In my appeal, I included Dr. R's initial letter along with a long one of my own (with attached documentation). I pointed out how " unreasonable and irrational " it is to expect their CIGNA clients to go on yet another 'doctor supervised weight loss attempt' and that in no other circumstance would CIGNA require someone to undergo 'therapy' with " a failure rate of 95% " because that, in itself, would be unethical. Even while considering my appeal, they asked for another form to be filled out regarding doctor supervised weight loss attempts. I refused and wrote a letter saying that they already had been given more than adequate information and reiterating my previous position. Well, as it turns out, the day I completed my response letter is the same day that they sent me my approval after their medical director had reconsidered my information. So, I never had to respond again. YEA! For anyone trying for CIGNA approval, I do believe that they will often stall and will almost invariably deny on the first attempt. However, persistence pays off. Stay focused and factual and let them know (in an unemotional way) that you are determined to obtain coverage (which is rightfully yours to begin with). Anyway, thanks for your encouragement. It's really helpful. Best of luck to you and everyone. Kris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2000 Report Share Posted June 25, 2000 Nettnewbie@... wrote: > > > KRIS! > > > > WOW 22lbs. WoooHoooo That is fantastic!!! Good for you winning that > appeal! > > Did you get denied because of an exclusion? or was it just BS?? > Keep us > > posted! margie SC > > Dear Margie, > Atta Girl! Rip em up! > Thanks a bunch. CIGNA denied me because I didn't have enough > documented " physician supervised weight loss attempts. " I am 40 > years old and been overweight my entire adult life. While I never > went to Craig type places -- I did everything else, including > being placed on an amphetamine for weight loss while I was a > teenager. > > My opinion was that CIGNA could find nothing else to deny me on > because I really did qualify (BMI 38 with comorbidities) under their > requirements. So, I think that 'BS' sums it up pretty well. In my > appeal, I included Dr. R's initial letter along with a long one of my > own (with attached documentation). I pointed out how " unreasonable > and irrational " it is to expect their CIGNA clients to go on yet > another 'doctor supervised weight loss attempt' and that in no other > circumstance would CIGNA require someone to undergo 'therapy' with " a > failure rate of 95% " because that, in itself, would be unethical. > > Even while considering my appeal, they asked for another form to be > filled out regarding doctor supervised weight loss attempts. I > refused and wrote a letter saying that they already had been given > more than adequate information and reiterating my previous position. > Well, as it turns out, the day I completed my response letter is the > same day that they sent me my approval after their medical director > had reconsidered my information. So, I never had to respond again. > YEA! > > For anyone trying for CIGNA approval, I do believe that they will > often stall and will almost invariably deny on the first attempt. > However, persistence pays off. Stay focused and factual and let them > know (in an unemotional way) that you are determined to obtain > coverage (which is rightfully yours to begin with). > > Anyway, thanks for your encouragement. It's really helpful. Best of > luck to you and everyone. > > Kris > > ------------------------------------------------------------------------ > Need to allergy-proof your bedroom? Pristine mattress > encasements form a breathable barrier that protects your family from > common allergens. Order one today and get two pillow encasements FREE! > http://click.egroups.com/1/5493/3/_/453517/_/961953335/ > ------------------------------------------------------------------------ > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > Please visit our web site at http://clos.net > Get the Patient Manual at http://clos.net/get_patient_manual.htm Quote Link to comment Share on other sites More sharing options...
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