Cigna PPO

[Guest shncon]

Hello,

I have Cigna PPO through my employer which is basically a self insured policy. I have gone through 3 appeals - all denied because of a suposed exclusion on the policy. I have never seen this exclusion, but they say it is there. I am now appealing through my employer since it is self funded, they can override the policy. If it gets denied again, I'll probably go through the Department of Insurance and then a lawyer. The policy that is available to employees says that it can be covered for medical necessity. The insurance company and my work say there is an exclusion and they won't give me a copy of the paperwork. I am 32, BMI of 50, 5'11, 360, have severe sleep apnea, venous stasis ulcers, family history of all kinds of weight related illnesses and have recently been diagnosed with diabetes. I need this surgery!!!! Anyone else have any advice?

[dishdiva 5]

Sounds like you've got the right game plan. I had Cigna PPO as well and was denied through the appeals process (with a lawyer). They claimed no medical necessity although I met requirements. Ended up paying myself.

Good luck!