Has anyone attended an Appeal Hearing?

[Shelby 0]

My case is with the National Appeals Unit (I have Cigna) and Walter & Kelley Lindstrom have been helping me with this. Kelley is anticipating a denial (based on her experiences). The next step would be an Appeal Hearing. Has anyone gone this far in the appeal process? I know I would have to attend but not sure what to expect. The Lindstroms will advise me but since they are in CA and I live in TX I'll be attending this alone. Has anyone attended one of these?

[Shelby 0]

I found out yesterday that the Appeal Hearing will be via phone and my attorney will be on the call with me! Big whew!

[cras253 0]

Shelby.....

Walter and Kellie helped me with my appeal to CIGNA. You will not be alone. For my appeal, CIGNA set up a date and time for a confernce call. A facilitator will handle the call. They get you on the line, then Walter/Kellie, and then the review board at CIGNA. Walter/Kellie does the talking and then the facilitator may/may not ask you to speak. In my case, they asked me for my input. Walter and Kellie are great. Stick with them and do what they ask you do do. You should be fine.

My appeal was approved. I have yet to schedule my surgery date as I am doing all of the pre-op testing. Once that's done, I will meet with my surgeon and schedule the date.

I will keep my fingers crossed for you!

Thanks,

Cindy

Tampa, FL

[Shelby 0]

Thank you Cindy! I can't tell you how much better I feel after reading your post. Kelley is great and she is hopeful about getting an appoval at the appeal hearing.

I'm so happy for you! Continue with your pre-op testing! You can do this! Let us know when you have a date - best of luck to you!

[cras253 0]

Shelby...Found out today I passed all of the pre-op testing! My surgical appointment is set for 08/30 with the surgery scheduled for 09/12. I will let you know how it goes. Any word from your appeal?

Later, Cindy

[Shelby 0]

Cindy - this is great news!! Congratulations on all your testings! I'm sure it's such a relief that it's over. Sept 12 - fantastic!

I have good news too - I've been approved!!! Cigna's legal counsel called my atty to say I was approved. Legal never calls on approval - we're assuming they received my paperwork the first time she sent it and they have 30 business days legally to approve/deny - at that point it was over 60. I'm just happy I'm approved.

Right now I'm waiting on a call back from my doctors office - need to schedule the pre-op testing. What type of pre-op tests did you have to complete?

Congratulations again!

[bigez1 0]

Shelby, Did your policy say that they might cover, or did your paperwork say that it Excluded any weight lost procedure?

I have United Healthcare and my policy actually Excludes any surgery or drug for weight lost.

Just wondering what I should do, pursue it or not.

I am 6'4" and over 450 lbs. my BMI is over 54

[Shelby 0]

Hi Bigez1, my policy does covers WLS so my battle will be different from yours. Cigna just kept saying no and I was forced to appeal.

From what I read here on this site - winning an appeal when there is no WLS coverage/rider is not too hopeful. But keep reading these posts - I know I have read someone recommending what one can do in this case. I'll see if I can find them....

Good Luck!

[cras253 0]

Shelby,

That's wonderful news! Congratulations!

I did several of the tests required on the first visit with my surgeon...Psych interview, interview with the surgeon and on the second appt I did the dietician and exercisologist. The ones I had to do before my 3rd appt, outside the surgeons office was a complte blood work up and urinalysis, chest x-ray and cario clearance (ekg, echo and stress test).

Later tater!

Cindy