Re: Third Appeal--Turned Down Again (Me Too)

[Guest guest]

, I have Cigna and lost my final appeal. I had a lawyer

represent me at my appeal. I complained to NC Insurance Commission

and they sided with Cigna. If WLS is listed as an exclusion it is

difficult to win. (In Cigna it is exclusion KK) I think someone else

just posted about Cigna. I can choose different insurance in

November,I am choosing my companys Self-Funded plan administered

through CoreSource. I already have a letter from my Benefits Dept.

that they will approve the surgery. If you can change your insurance

for next year that would be the way to go. It would be a lot less

expensive than hiring a lawyer. My lawyer did a good job, but the

exclusion couldn't be beat. , Denver, NC MGB hopeful for January

> Blue Cross and Blue Shield have denied me for the third time. This

> letter was down right rude. They came right out and put it in

print

> get a lawyer and contact our legal department. No discussion of the

> associated illnesses. So I guess I start running up the insurance

> and get official diagonsis of all of them and get my attorney to go

> from there. I guess its going to be a long drawn out fight.

[Guest guest]

Hi,

My name is Calissa and I was reading about what you wrote about Cigna of NC

and I was wondering if your plan was hmo or ppo. I just read something about

Cigna from somebody else and they were approved and they were in NC. I'm in

Texas and had Cigna. I currently have hmo but next month im changing to ppo

and it will become effective jan 1. I'm doing this soley because my pcp told

me that there would be no way in hell cigna hmo would approve this,

especially since it will out of state! Any help you could give would be much

appreciated!!

Calissa

>From: srozycki@...

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

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

>Subject: Re: Third Appeal--Turned Down Again (Me Too)

>Date: Sat, 07 Oct 2000 15:08:48 -0000

>

>, I have Cigna and lost my final appeal. I had a lawyer

>represent me at my appeal. I complained to NC Insurance Commission

>and they sided with Cigna. If WLS is listed as an exclusion it is

>difficult to win. (In Cigna it is exclusion KK) I think someone else

>just posted about Cigna. I can choose different insurance in

>November,I am choosing my companys Self-Funded plan administered

>through CoreSource. I already have a letter from my Benefits Dept.

>that they will approve the surgery. If you can change your insurance

>for next year that would be the way to go. It would be a lot less

>expensive than hiring a lawyer. My lawyer did a good job, but the

>exclusion couldn't be beat. , Denver, NC MGB hopeful for January

>

>

>

> > Blue Cross and Blue Shield have denied me for the third time. This

> > letter was down right rude. They came right out and put it in

>print

> > get a lawyer and contact our legal department. No discussion of the

> > associated illnesses. So I guess I start running up the insurance

> > and get official diagonsis of all of them and get my attorney to go

> > from there. I guess its going to be a long drawn out fight.

>

>

>

[Guest guest]

Hi Calissa, my plan was a PPO but becuase weight loss surgery was

specifically listed as an exclusion, I could not win on appeal. Read your

patient manual and see if WLS is listed as an exclusion. All plans are

different, if Cigna is just acting as an administrator of the plan for your

company then their decision could be overridden. I have been working with

my benefits dept since August. I was very careful not to sound threatening

to them, but I made it clear to them, that as an employee I didn't feel I

was being treated fairly by Cigna, and if they could not get Cigna to change

their minds then direct me to a new policy for the upcoming year. The

benefits manager was great, she researched and sent Dr. R's and my PCP

letter to the various plans. I am going to be able to go to company

self-funded plan which is administered by CoreSource. Hopefully you can do

the same. , MGB hopeful since 2/19

Re: Third Appeal--Turned Down Again (Me Too)

> >Date: Sat, 07 Oct 2000 15:08:48 -0000

> >

> >, I have Cigna and lost my final appeal. I had a lawyer

> >represent me at my appeal. I complained to NC Insurance Commission

> >and they sided with Cigna. If WLS is listed as an exclusion it is

> >difficult to win. (In Cigna it is exclusion KK) I think someone else

> >just posted about Cigna. I can choose different insurance in

> >November,I am choosing my companys Self-Funded plan administered

> >through CoreSource. I already have a letter from my Benefits Dept.

> >that they will approve the surgery. If you can change your insurance

> >for next year that would be the way to go. It would be a lot less

> >expensive than hiring a lawyer. My lawyer did a good job, but the

> >exclusion couldn't be beat. , Denver, NC MGB hopeful for January

> >

> >

> >

> > > Blue Cross and Blue Shield have denied me for the third time. This

> > > letter was down right rude. They came right out and put it in

> >print

> > > get a lawyer and contact our legal department. No discussion of the

> > > associated illnesses. So I guess I start running up the insurance

> > > and get official diagonsis of all of them and get my attorney to go

> > > from there. I guess its going to be a long drawn out fight.

> >

> >

> >