Re: I can't see through the tears ..call me

[Guest guest]

Donna call me.I had Cigna when I had my surgery and the dr. was out of

net-work.I would like to help if i can.(601)376-0083

MELANIE TAYLOR

-60#'S

7-10-01/OPEN/BPD/DS

DR.KEITH KIM/ OCEAN SPRINGS,MISSISSIPPI

joostema@... wrote: It's strange that I come to the group at a time

when I am so very

upset; you don't know me nor love me as my family and friends do, yet

it is the people of this group whom I've become familiar with through

months of post reading that I need right now.

I got my second denial from Cigna this afternoon. I know it

shouldn't have surprised me so nor upset me to the extent that I can

barely see through teary eyes to type this, but it has.

My first denial was received upon the request for authorization to

see Dr. Hess (out of network). When that was denied, I started the

appeals process, knowing I would keep and pay for the trip to see Dr.

Hess on 10/15. I spent so much time... I typed a 14 page document

all about myself, the choice of surgeon, the surgery itself, the

pitfalls of RNY, weight loss attempts, medications, comorbids,and on

and on ... including 6 attachments to back up what I had to say.

They received my appeal package on the 25th of September, and the

bastards didn't even look at it unitl last week. They did not even

go the length to determine medical necessity. All they looked at was

that it was a request for out-of-network benefits and that as there

were in-network surgeons providing bariatric surgery, they denied.

I am sitting here today, nowhere further than I was when I got the

refusal to see Dr. Hess, nearly 2 months ago. I asked her why they

didn't determine medical necessity, and just deny out-of-network

benefits, and she told me that was because I requested out-of-network

benefits which didn't require establishing medical necessity in order

to be denied. I cannot believe this. She told me I can appeal

again, and I will, but I feel so emotionally beaten.

She did go on to tell me that North Carolina insurance policies can

deny wls for obese persons but that they cannot deny wls for persons

classified as MO. I told her that with a BMI of 48 and a foot long

list of comorbids THEY ARE HAVING TO PAY FOR, I certainly qualify.

She said that will have to be determined in the next level of appeals.

So .... it seems I have to appeal not only for the BPD/DS to be done

versus the RNY, but I have to appeal to have them acknowledge I am

MO ... which any idiot could've/should've gotten from my last appeals

package. I even had 5 ... yes 5 ... letters from my doctors ... 4

from surgeons and one from my PCP, all advocating this is medically

necessary.

I need a hug ... I need a really really really big hug ... and an

even bigger glass of whisky...

I am so depressed and feel so hopeless,

Donna

----------------------------------------------------------------------

[Guest guest]

,

I will call you ... I came home from work (no wonder, huh?) and decided to

call Cigna back and question how they could've handled my appeal in such a

manner as to have looked at NOTHING but the out-of-network piece. She

agrees communications have been amiss and that I should not have to start at

ground zero with the appeal. She has at least made me feel better in that

she understands what I'm saying and agrees something is wrong. She has

promised to call me prior to 5:00 p.m. today (so I want to keep the phone

lines free right now)to let me know what will happen next.

I will call you as soon after that as I can. Thank you, . Thank you

so much ... I have a sense of peace knowing I'll get input from someone

else.

Talk to you very soon,

Donna

>

>

> Donna call me.I had Cigna when I had my surgery and the dr. was out of

>net-work.I would like to help if i can.(601)376-0083

>MELANIE TAYLOR

>-60#'S

>7-10-01/OPEN/BPD/DS

>DR.KEITH KIM/ OCEAN SPRINGS,MISSISSIPPI

_________________________________________________________________

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[Guest guest]

Hi Donna-I am so sorry to hear all of this. You deserve this surgery and

must continue to fight. It will be the best thing you can do for yourself.

I am here for you. Feel free to call or write. Ellen(Pam