Guest guest Posted June 2, 2000 Report Share Posted June 2, 2000 Find out what doctors they approve. Get their average time in surgery for the procedure (usually 4-8 HOURS), their surgical fee, the anaesthesia fee, and the average hospital stay and hospital bill. Then show them how much less expensive it is and how much less time (1/2 hour in surgery and 1.5 days in hospital) you spend in the hospital and recovering, with the laparascopic version. Just the 1/2 hour for surgery alone cuts the surgical bill, anaesthesia bill, and hospital Operating room bill to less than 1/5 of what the open procedure costs. Insurance is about money. Show them how their decision will cost them *more* money and how the laparscopic MGB will cost them *less.* You might also pay a lawyer $25 to write a letter to them with these facts and stating that since their decision appears to be nonsensical, arbitrary and capricious, they have breached their fiduciary duties under ERISA and that you intend to pursue your full rememdies under law against them if this is not remedied immediately. 47, 5'4 " , 249 lbs. Surg. date: May 18, 2000 Current wt. (2 weeks, 1 day): 234 (that's a pound a day!) No complications, no problems, nada. > It took a month and numerous sends to get Cigna to acknowledge my > request for pre-approval. It took only eight days to get a letter > back stating: > > " We have determined that although a gastric bypass may be > indicated, the laproscopic approach is not considered to be essential > for the necessary care and treatment of an illness or injury, and > therefore is not a covered expense. " > > I plan to appeal, but would like thoughts on my approach. It appears > to me that they are not denying me Gastric Bypass, they just don't > want me to have it laproscopicly. Any ideas? Thoughts? > > Ann > Wanting to cross to the other side... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 2, 2000 Report Share Posted June 2, 2000 > It took a month and numerous sends to get Cigna to acknowledge my > request for pre-approval. It took only eight days to get a letter > back > Ann > Wanting to cross to the other side... Dear Ann, Well, unfortunately for us, we are in the same 'Cigna boat.' I have found Cigna (of Florida) to be almost intolerable to deal with. In some ways, however, you have had more luck with them than I. They flat out denied my initial request from Dr. R stating to Debbie that they need evidence of " more medically supervised diet attempts. " (20 years of dieting including medication/Optifast/hypnotherapy/etc. just wasn't enough!) They did not offer any opportunity for further documentation (not that there was anything left to document.) Even Debbie, who deals with insurance all the time, was suprised that they didn't even allow for some additional info before denying. Also, this was only told over the phone to Dr. R's office. They did not put ANYTHING in writing. Do I think that's suspicious? Yes, of course. They don't want to put that in writing though I did make them record an official request for a written denial. They are " considering my request " to have a copy of the denial. Unbelievable, huh? Also, they will not release any information of any kind regarding referrals, requests, appeal status, etc. to me either in writing or over the phone. ( " Your doctor must call for any information. We do not release that information to patients. " ) I let them know what I thought about this policy . . . I get it, my husband and I get to pay a fortune every month for lousy insurance coverage and they won't even talk to me about it. Yet, " anyone " from the doctor's office can get the information -- including a secretary or receptionist. I don't get it. Anyway, when they denied, I got depressed for about 24 hours and then got very busy writing a very detailed and organized appeal which I promptly filed. I sent it certified so they had to sign for it -- as they always seem to deny recieving requests. (They continued to deny even recieving my initial request long AFTER they had denied it!) My appeal was recieved three weeks ago today. Barbara called and they told her today " It is still under review. " I will appeal again if they refuse and send a copy of that appeal to the insurance commissioner at the same time. If that doesn't do the trick (& I bet it does), I will consider legal action against them. In the meantime, I have scraped together the $ and will proceed without them. But believe me, I will not give up on my appeal. Didn't mean to ramble but wanted to let you know (& anyone else fighting Cigna) that you are not alone. If my appeal works, I will be happy to let you know what I did. Let me know if you have any luck. Best wishes, Kris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 2, 2000 Report Share Posted June 2, 2000 > It took a month and numerous sends to get Cigna to acknowledge my > request for pre-approval. It took only eight days to get a letter > back > Ann > Wanting to cross to the other side... Dear Ann, Well, unfortunately for us, we are in the same 'Cigna boat.' I have found Cigna (of Florida) to be almost intolerable to deal with. In some ways, however, you have had more luck with them than I. They flat out denied my initial request from Dr. R stating to Debbie that they need evidence of " more medically supervised diet attempts. " (20 years of dieting including medication/Optifast/hypnotherapy/etc. just wasn't enough!) They did not offer any opportunity for further documentation (not that there was anything left to document.) Even Debbie, who deals with insurance all the time, was suprised that they didn't even allow for some additional info before denying. Also, this was only told over the phone to Dr. R's office. They did not put ANYTHING in writing. Do I think that's suspicious? Yes, of course. They don't want to put that in writing though I did make them record an official request for a written denial. They are " considering my request " to have a copy of the denial. Unbelievable, huh? Also, they will not release any information of any kind regarding referrals, requests, appeal status, etc. to me either in writing or over the phone. ( " Your doctor must call for any information. We do not release that information to patients. " ) I let them know what I thought about this policy . . . I get it, my husband and I get to pay a fortune every month for lousy insurance coverage and they won't even talk to me about it. Yet, " anyone " from the doctor's office can get the information -- including a secretary or receptionist. I don't get it. Anyway, when they denied, I got depressed for about 24 hours and then got very busy writing a very detailed and organized appeal which I promptly filed. I sent it certified so they had to sign for it -- as they always seem to deny recieving requests. (They continued to deny even recieving my initial request long AFTER they had denied it!) My appeal was recieved three weeks ago today. Barbara called and they told her today " It is still under review. " I will appeal again if they refuse and send a copy of that appeal to the insurance commissioner at the same time. If that doesn't do the trick (& I bet it does), I will consider legal action against them. In the meantime, I have scraped together the $ and will proceed without them. But believe me, I will not give up on my appeal. Didn't mean to ramble but wanted to let you know (& anyone else fighting Cigna) that you are not alone. If my appeal works, I will be happy to let you know what I did. Let me know if you have any luck. Best wishes, Kris Quote Link to comment Share on other sites More sharing options...
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