Guest guest Posted June 1, 2000 Report Share Posted June 1, 2000 --- Ann , Sounds like you have your foot in the door. Try the the following FREE group for additional help and also DR R to help you with an appeal.OOps it says it is not there anymore..the OSSG.helponinsurance.......does anyone know what happened to that group? In MiniGastricBypass (AT) e, " Ann " wrote: > 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 In a message dated 6/2/2000 3:36:44 PM Eastern Daylight Time, lindat@... writes: << 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. >> That's great !!!!!!!!!!!! Wanting to be on the other side, Cathy in Lenoir, NC Patient Info Emailed on 5/2/00 BMI 42 " A Journey Of A Thousand Miles Begins With A Single Step! " Quote Link to comment Share on other sites More sharing options...
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...
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