A MIRACLE!!! (long)

[Guest guest]

Hi Everyone, It's been a long time since I've posted, but I just had

to let you know that a true miracle has happened! As I reported

awhile back my insurance (Cigna Healthcare of Ohio HMO) denied me the

BPD/DS (although they were willing to pay for the RNY). As depressing

as that was, with the encouragement of some very special friends who

are part of Dr Maguires group (in Kettering Ohio), I decided to

appeal. When I called and asked for the criteria on which they based

my denial on, they told me that those details would be in Dr M's

denial letter. Four weeks and numerous phone calls later, Dr M

received his letter and much to my frustration, it was the SAME

letter they sent me, very vague. So I called Cigna and firmly told

them I wanted a letter that explained exactly what they based their

denial on. Then I was told they couldn't give that to me, it was

" privileged " information and only the Dr. could have that info, boy

was I mad! I made several calls to find out if this was true and

couldn't get a straight answer from anyone. So I called Kim at Dr.

M's office and asked her if she would please call and get the info

for me. She called and strongly requested that the criteria they

based their denial on be sent to their office right away. That was

Thursday and Monday I received a call Dr Maguire's office, saying,

that my case had been sent before a board of medical review and my

policy had " changed " so I was APPROVED!! I was so shocked that I

asked her to make sure she had the right person as I hadn't even sent

in an appeal yet! But it is TRUE, I'm approved! My date is Oct 29th

and I am so very excited! When I asked Kim (the nurse at Dr M's

office) what she thought changed their minds she said she thought

maybe they really didn't have any criteria they based their decision

on and was hoping I'd just give up! So please, anyone out there still

fighting, DON'T GIVE UP! Make them spell it out for you so you can go

point by point and appeal it. I wish anyone still fighting, all the

luck in the world! Keep close with those that will support you when

you want to give up. And FIGHT! Sincerely, Angel