Re: Chris is Cigna approved!!!!!

June 22, 2000

Wow, Deb!

What a bunch of baloney! It sounds to me like they are very prejudiced

against Dr R to begin with, but I guess you have no choice but to do what

they ask. I wish you all the best. I will send you a copy of my letters of

appeal if it will help. Let me know, (if I have already sent them to you,

forgive me.....) Best of luck and keep fighting! You might consider a

letter from an attorney. I know this is another expense, but current

practice does allow the MGB to people with BMI's above 40.

Regards,

Debbie in IL

Cigna approved on 3rd appeal for daughter (BMI 45)

Counting on Cigna for Debbie (BMI 40)--online form submitted 6/22

In a message dated 6/22/00 3:23:37 PM Pacific Daylight Time, Hadjab@...

writes:

<<

Congratulations! That is great news... your perserverence paid off. I am

in

the middle of a problem getting approved. I have BCBS, and last Friday,

they

told me on the phone that I needed to send in a psych evaluation and a

nutritional counseling note... Well, I had the psych evaluation Monday, and

luckily, I am not psychotic... Whew, that was a relief to hear...LOL.. And,

my PCP wrote a letter saying that I had had nutritional counseling in the

past. Then yesterday, I got a copy of a letter from my ins. co, and it says

the nutritional counseling has to be done by a dietician, so I'll have to

have it redone, and they will not even consider approving me until I have

had

an appointment with Dr. R... I am in IL, so I hope if I go to the expense of

an extra trip to NC, they will approve me... Between the pysch appt ($200),

Dietician (probably at least $100), airfare, (I called Joanne, a real

sweetheart, I can get round trip Chicago to Raleigh for $163), and hotel

(Fairfield Inn for $39) since I can't get an early morning flight the day I

have a clinic appt, on top of a rental car or cab fees, I will be running

into a good deal of money, especially if I'm going to end up being a self

pay. Does anyone have any ideas of what, if anything I should put in with

the additional info? I pointed out to the nurse at medical review that the

MGB is much cheaper, has a higher success rate, and a much lower

complication

rate. She seemed very pessimistic. She said they had had another request

from Dr. R in the past, and they didn't like the idea that he doesn't see

the

patient until just before surgery. I explained that he was just trying to

save his patients money, since most of us come from all over the US to have

this procedure. She also mentioned that they didn't like the MGB because it

is still " investigational " . So, I am less optimistic than I was, but I

scheduled a clinic appt. for July 11, and hopefully, after I give them what

they wasnt, they will approve me. Either way, I am hoping to keep my

surgery

date of August 2. Any advice on how to sway my review board in the right

direction will be appreciated!

Thanks!!

Deb in IL

------------------------------------------------------------------------

Air >>

June 22, 2000

Thanks Deb, I would love to see your appeal letter if it's not too much

trouble. My husband also said that I should get a lawyer to send a letter.

He says it's not fair the way they are jerking me around. I have not told

him I have to go to Durham to see Dr. R on July 11, he is probably going to

have a cow when he finds out about the extra trip.... lol Maybe I won't tell

him... might just tell him I'm taking a really loooong bath .. he he

he....Guess even he wouldn't fall for that after about 22 hours... Can you

send your appeal letter to me via email? Or do you need my address? Thanks

alot for your help!

Deb

June 22, 2000