Guest guest Posted June 2, 2000 Report Share Posted June 2, 2000 Dear Ann, Please don't say it's so...how ridiculous! You need to send an appeal letter showing them HOW much longer the hospital stay is if you have the 'wide open' gastric bypass. I do not understand Cigna. I just wrote a letter to the head of insurance in my husbands company. She is trying to speed up the process. I told the lady there to pass on the message to Cigna that by making us wait so long, all of our lab values are useless and will have to be repeated causing 'them' to pay out more money and us having to pay our 10 or 20% of the costs additionally. Are you going to try the new insurance company? Or stick with Cigna? Good Luck Sis! Love, > 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 Dear Ann, Please don't say it's so...how ridiculous! You need to send an appeal letter showing them HOW much longer the hospital stay is if you have the 'wide open' gastric bypass. I do not understand Cigna. I just wrote a letter to the head of insurance in my husbands company. She is trying to speed up the process. I told the lady there to pass on the message to Cigna that by making us wait so long, all of our lab values are useless and will have to be repeated causing 'them' to pay out more money and us having to pay our 10 or 20% of the costs additionally. Are you going to try the new insurance company? Or stick with Cigna? Good Luck Sis! Love, > 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 Dear Ann, Please don't say it's so...how ridiculous! You need to send an appeal letter showing them HOW much longer the hospital stay is if you have the 'wide open' gastric bypass. I do not understand Cigna. I just wrote a letter to the head of insurance in my husbands company. She is trying to speed up the process. I told the lady there to pass on the message to Cigna that by making us wait so long, all of our lab values are useless and will have to be repeated causing 'them' to pay out more money and us having to pay our 10 or 20% of the costs additionally. Are you going to try the new insurance company? Or stick with Cigna? Good Luck Sis! Love, > 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 Ann, we are having the same problem in Michigan with BCBS. We are deemed experimmental. has a good post called denied. I think she has some good ideas. It might not be a bad idea to get a letter from an attorney to send with the appeal. Its worth a try. Sorry <:[ Dear Ann, > > Please don't say it's so...how ridiculous! You need to send an > appeal letter showing them HOW much longer the hospital stay is if > you have the 'wide open' gastric bypass. I do not understand Cigna. > I just wrote a letter to the head of insurance in my husbands > company. She is trying to speed up the process. I told the lady > there to pass on the message to Cigna that by making us wait so long, > all of our lab values are useless and will have to be repeated > causing 'them' to pay out more money and us having to pay our 10 or > 20% of the costs additionally. Are you going to try the new > insurance company? Or stick with Cigna? Good Luck Sis! > Love, > > > > > 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... > > > ------------------------------------------------------------------------ > Was the salesman clueless? Productopia has the answers. > http://click.egroups.com/1/4633/2/_/453517/_/959976409/ > ------------------------------------------------------------------------ > > 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...
Guest guest Posted June 2, 2000 Report Share Posted June 2, 2000 Ann, we are having the same problem in Michigan with BCBS. We are deemed experimmental. has a good post called denied. I think she has some good ideas. It might not be a bad idea to get a letter from an attorney to send with the appeal. Its worth a try. Sorry <:[ Dear Ann, > > Please don't say it's so...how ridiculous! You need to send an > appeal letter showing them HOW much longer the hospital stay is if > you have the 'wide open' gastric bypass. I do not understand Cigna. > I just wrote a letter to the head of insurance in my husbands > company. She is trying to speed up the process. I told the lady > there to pass on the message to Cigna that by making us wait so long, > all of our lab values are useless and will have to be repeated > causing 'them' to pay out more money and us having to pay our 10 or > 20% of the costs additionally. Are you going to try the new > insurance company? Or stick with Cigna? Good Luck Sis! > Love, > > > > > 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... > > > ------------------------------------------------------------------------ > Was the salesman clueless? Productopia has the answers. > http://click.egroups.com/1/4633/2/_/453517/_/959976409/ > ------------------------------------------------------------------------ > > 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...
Guest guest Posted June 2, 2000 Report Share Posted June 2, 2000 Ann, we are having the same problem in Michigan with BCBS. We are deemed experimmental. has a good post called denied. I think she has some good ideas. It might not be a bad idea to get a letter from an attorney to send with the appeal. Its worth a try. Sorry <:[ Dear Ann, > > Please don't say it's so...how ridiculous! You need to send an > appeal letter showing them HOW much longer the hospital stay is if > you have the 'wide open' gastric bypass. I do not understand Cigna. > I just wrote a letter to the head of insurance in my husbands > company. She is trying to speed up the process. I told the lady > there to pass on the message to Cigna that by making us wait so long, > all of our lab values are useless and will have to be repeated > causing 'them' to pay out more money and us having to pay our 10 or > 20% of the costs additionally. Are you going to try the new > insurance company? Or stick with Cigna? Good Luck Sis! > Love, > > > > > 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... > > > ------------------------------------------------------------------------ > Was the salesman clueless? Productopia has the answers. > http://click.egroups.com/1/4633/2/_/453517/_/959976409/ > ------------------------------------------------------------------------ > > 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...
Guest guest Posted June 2, 2000 Report Share Posted June 2, 2000 To everyone who responded to my crisis: Thank you so much. You are all a wonderful support system. I won't quit. I am planning to appeal to Cigna, letting them know that I won't just go away. My next request is to ask anyone who has been approved by Cigna to contact me. I am working on my appeal letter and wish to use examples of people who were approved by Cigna. The odd thing is, Dr. Rutledge is part of their network! I am not even asking to go out of network on this. So, for everyone who has Cigna and has been denied, I will carry on. Each time one of us is approved is a victory for all of us. The more people that get approved, the stronger the case is for the rest of us. I will try the appeal on my own, but may hire an attorney to write a letter. Let's keep our heads up! We WILL win! Ann Quote Link to comment Share on other sites More sharing options...
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