Re: Appeal letter - RHONDA

[Guest guest]

Rhonda C wrote:

>

> Hi everyone. This is Rhonda from Indiana. I am in the process of

> appealing Cigna's denial of coverage for the MGB. I have the appeal

> letter from Dr. R, my letter, my husband wrote a letter also, I have

> asked my PCP to write a letter also, he has not told me if he is

> willing to do that. My question is, did any of you appeal your

> insurance company's decision without having an appeal letter from

> your PCP?

>

> Thanks, Rhonda

Yes. First and foremost, what is the basis for the denial?

[Guest guest]

> My question is, did any of you appeal your

> > insurance company's decision without having an appeal letter from

> > your PCP?

> >

> > Thanks, Rhonda

>

>

> Yes. First and foremost, what is the basis for the denial?

They require that I show three separate twelve week doctor supervised

weight loss attempts, one being in the last year. They also said I

didn't have severe enough co-morbities. I have had a weight loss

attempt in the last year. My doctor put me on Xenical. I was only

on it for 1 - 1 1/2 months because of side effects. I also lost no

weight in the time I was on it. Two years ago I was on the optifast

program. I lost 65 pounds and gained it all+ back when I went back

on regualr foods. They want me to try another diet. I gave them a

list of at least 20 different diet attempts I have made in the last

20 years. I don't think I can go through the humiliation of another

diet. I really feel that I have tried to lose this weight without

surgery, it just isn't going to happen for me. I am having problems

with even the most basic things in life, like showering and dressing

myself, I have had high blood pressure, it is better right now, but I

am sure it will go back up since I have put all the weight back on.

I am on medication for elevated cholesterol and triglycerides. I have

joint pain, feet pain, back pain, etc...I could go on and on as I am

sure you know. I am also on medication for depression, which only

seems to get worse. I am 5' 3 " and my BMI is 48, so I do qualify for

surgery on weight alone. I'm really not satisfied with my appeal

letter. I am going to try to re-write it. I am having a real hard

time putting on paper how I feel and what my daily life is like for

some reason. Thanks for listening to me whine again.

Rhonda

[Guest guest]

> My question is, did any of you appeal your

> > insurance company's decision without having an appeal letter from

> > your PCP?

> >

> > Thanks, Rhonda

>

>

> Yes. First and foremost, what is the basis for the denial?

They require that I show three separate twelve week doctor supervised

weight loss attempts, one being in the last year. They also said I

didn't have severe enough co-morbities. I have had a weight loss

attempt in the last year. My doctor put me on Xenical. I was only

on it for 1 - 1 1/2 months because of side effects. I also lost no

weight in the time I was on it. Two years ago I was on the optifast

program. I lost 65 pounds and gained it all+ back when I went back

on regualr foods. They want me to try another diet. I gave them a

list of at least 20 different diet attempts I have made in the last

20 years. I don't think I can go through the humiliation of another

diet. I really feel that I have tried to lose this weight without

surgery, it just isn't going to happen for me. I am having problems

with even the most basic things in life, like showering and dressing

myself, I have had high blood pressure, it is better right now, but I

am sure it will go back up since I have put all the weight back on.

I am on medication for elevated cholesterol and triglycerides. I have

joint pain, feet pain, back pain, etc...I could go on and on as I am

sure you know. I am also on medication for depression, which only

seems to get worse. I am 5' 3 " and my BMI is 48, so I do qualify for

surgery on weight alone. I'm really not satisfied with my appeal

letter. I am going to try to re-write it. I am having a real hard

time putting on paper how I feel and what my daily life is like for

some reason. Thanks for listening to me whine again.

Rhonda

[Guest guest]

Hi Rhonda !!

Glad to hear from you ! I was getting worried since I've not heard from you

since I sent you a copy of my appeal letter to Cigna. I had my PCP send a

letter of recommendation intially, that was when I was denied. I sent a

copy of that letter ..with Dr.R's letter and my appeal letter to Cigna for

the appeal. I truly in my heart believe it was because of Dr.R's letter

along with my letter that got my approval. The lady at member services

told me to make the appeal letter VERY VERY personal. Talk from your heart

Rhonda...just like you did...talk to her like she is one of us. Dont give

up, they just want you to show them that you are really serious about

this...someone once suggested that they believed that alot of times the

insurance companines will deny to weed out those that are truly serious, and

those that were just throwing it out there...

My thoughts are with you,

>

>Reply-To: MiniGastricBypass (AT) egroups (DOT) com

>To: MiniGastricBypass (AT) egroups (DOT) com

>Subject: Re: Appeal letter - RHONDA

>Date: Mon, 17 Jul 2000 20:27:55 -0000

>

>

> > My question is, did any of you appeal your

> > > insurance company's decision without having an appeal letter from

> > > your PCP?

> > >

> > > Thanks, Rhonda

> >

> >

> > Yes. First and foremost, what is the basis for the denial?

>

>

>They require that I show three separate twelve week doctor supervised

>weight loss attempts, one being in the last year. They also said I

>didn't have severe enough co-morbities. I have had a weight loss

>attempt in the last year. My doctor put me on Xenical. I was only

>on it for 1 - 1 1/2 months because of side effects. I also lost no

>weight in the time I was on it. Two years ago I was on the optifast

>program. I lost 65 pounds and gained it all+ back when I went back

>on regualr foods. They want me to try another diet. I gave them a

>list of at least 20 different diet attempts I have made in the last

>20 years. I don't think I can go through the humiliation of another

>diet. I really feel that I have tried to lose this weight without

>surgery, it just isn't going to happen for me. I am having problems

>with even the most basic things in life, like showering and dressing

>myself, I have had high blood pressure, it is better right now, but I

>am sure it will go back up since I have put all the weight back on.

>I am on medication for elevated cholesterol and triglycerides. I have

>joint pain, feet pain, back pain, etc...I could go on and on as I am

>sure you know. I am also on medication for depression, which only

>seems to get worse. I am 5' 3 " and my BMI is 48, so I do qualify for

>surgery on weight alone. I'm really not satisfied with my appeal

>letter. I am going to try to re-write it. I am having a real hard

>time putting on paper how I feel and what my daily life is like for

>some reason. Thanks for listening to me whine again.

>

>Rhonda

>

>

>

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