Awaiting approval - Cigna

[peacheeie 14]

Wow....I'm so happy for all that were approved by cigna...congrats and good luck!! I however, was not that lucky. I was denied and then my surgeon had a peer to peer on Thursday...DENIED!!! My BMI is 32.5 so basically it was cut and dry, no sleeve If under 35 even with co mortalities. I actually cried to the poor surgical coordinator...my band was removed sept 19 and I have gained almost 30 lbs! So, I have to gain 20 more to get the sleeve, maybe, or I can probably get another band...wtf!!!! I was told that there is no appeal once the peer to peer has happened....can I appeal???

[becweaves 67]

Yes, Peachee, go ahead and submit a written appeal however because of your BMI and lack of co-morbidities I don't know that they will approve :-( so sorry!

[peacheeie 14]

Ty becweaves...I do have co mortalities...hpb, rheumatoid arthritis & degenerative disk disease. I wa seriously thinking about going back to the band but honestly, I don't want too...ate Soup for the last 6 years and made excuses on going out to dinner thousands of times! Also, I am now reading reports that the band is being linked to RA. I received the letter of denial and I'm going to appeal....any wording suggestions for my letter?

[Jersrose43 837]

I would document all the issues you have. Including starting weight all those years ago and that by removing the sleeve without another tool will just cause regain.

Make sure that you clearly document what issues you have that are weight related - asthma, sleep apnea.

Tell them what will be resolved with continued weight loss.

You must appeal factually and not with your heart

You should include all the health outcomes you can muster as CIGNA is a health services company not an insurance company.

Appeal to the healthy goal of theirs.

How much more you will cost them if you gain weight.

Can never hurt.

Further - call Cigna. Is your plan paid for by an employer? Ask if the employer has an aso account. If yes- talk to your hr people and see who at yor company makes insurance decisions

Cigna is just the servicing company. Your employer is who is ultimately paying. Hope that makes sense

[peacheeie 14]

Great...very helpful. My plan is through my employeer...never thought of calling HR...great idea. When you say appeal to the healthy goal of theirs , what does that mean...are you referring to the vitality points and healthy lifestyle they push down our throats?

[newstartme 24]

Wow....I'm so happy for all that were approved by cigna...congrats and good luck!! I however, was not that lucky. I was denied and then my surgeon had a peer to peer on Thursday...DENIED!!! My BMI is 32.5 so basically it was cut and dry, no sleeve If under 35 even with co mortalities. I actually cried to the poor surgical coordinator...my band was removed sept 19 and I have gained almost 30 lbs! So, I have to gain 20 more to get the sleeve, maybe, or I can probably get another band...wtf!!!! I was told that there is no appeal once the peer to peer has happened....can I appeal???

The pier and pier does not stop there! Believe me i went trough it! Go to the final step keep fighting

[Jersrose43 837]

Yes they are a health promotion machine. Make sure you cram it down their throats

[becweaves 67]

@@peacheeie I have a letter that I used for my appeal that I can send you. Send me your email address and I will send you what I used

Edited November 1, 2014 by becweaves

[Jersrose43 837]

Also read page 3 of my earlier post of cogna medical policy. You must document the failure of the band.

It says nothing about your bmi requirement.

Read it carefully. In your appeal use those requirements and answer how you meet that bullet

[peacheeie 14]

Ty Ty ty

[vsgchick 118]

Also, I am now reading reports that the band is being linked to RA. I received the letter of denial and I'm going to appeal....any wording suggestions for my letter?

I haven't heard about the band being linked to RA. However, having RA is what kept me from pursuing the band. My insurance said they wouldn't approve the band due to my existing autoimmune disease (my immune system would eventually attack the band), so it was sleeve or bypass. I am going to be sleeved this month. Good Luck with your appeal.