Journal Continued
6/23/03 Well I sent my appeal to our Benefits department who is assisting me in the Cigna problem; they were also surprised with my challenges. I sent a 2” binder overnight to them last Monday they in turn made a copy of my packet and sent it to Cigna to start the waiting game again. I have been told it may take around 15-25 days for a decision and letter to be sent, just more delay tactics and games with peoples life’s to protect that almighty dollar. I’m well over two hundred pounds with some medical problems and can not believe they have denied me this surgery. I wish that there were a class action case on Weight Loss Surgery for Morbid Obesity People vs. All HMO’s or something like that; I would be in this line in a heart beat. Enough with that and back to what I sent in my packet to everyone and have a backup copy ready to be sent to Walter Lindstrom if needed.
Packet content included:
1. Appeal letter
2. A copy of my home page
3. Cigna/Intracorp Guideline discrepancies
4. Dr Atkinson Records and previous submitted paperwork
5. Primary Care Physician Records
6. Diet History – All diets total over 52 weeks, Military weight chart, PCP records, Kaiser Records, Jenny Craig contract/weight chart, Gold’s Gym contract/diet menu’s
7. Cardiovascular Records
8. Pulmonary Records
9. Orthopedic Records
10. Sleep Study test – 1996 Kaiser Records
11. Dr. Fisher’s 9 rules for your new tool
This packet was received on Wednesday 6/18/03 by Cigna.
I just completed a new sleep study on June 15 and waiting on results and will forward to Cigna if needed. My wife also completed a sleep study last month and everything was fine with her test, however Cigna has denied the claim for this test and made a statement that they do not cover obesity weight loss testing. They are submitting it for a case review and should have an answer in 10-15 days on a decision paying or not and my claim will be sent in shortly for my sleep study retest. I’m hoping my company is taking a very good look at the various problems that I have been having and my co-workers have experienced recently with obesity issues, testing and medication. In today’s society with Obesity being a major problem I  feel they should be encouraging all of the employee’s that contemplate this journey to resolve obesity issues, this surgery is not the miracle cure but a tool to weight loss. With this new tool and the support of family, friends, co-workers, Surgical Weight Loss Center and various support groups I will win my battle with this disease of obesity.  I will fight this fight to the end, to be Cigna’s worst pain and seek legal action if needed and make them pay dearly. MY IRISH TEMPER HAS AWAKEN


6/27/03 Yesterday I received some good news, sorry not from Cigna, but from Kaplan College that I was given a Criminal Justice Scholarship. This will help cut down my cost for this school, thank God, so I start class in mid July. I was hoping that I would have had this surgery by now, however this is not the case. Cigna still dragging their feet or maybe it’s their eye balls and there blind, what ever the case they are taking to long in my book. Maybe I should look into taking a stress management class and see if anything changes with me “Not”.
Any way Dana From my Benefits Group has kept me up to date as much as possible, but she still has not responded to the discrepancy in the guidelines from Cigna/Intracorp. I believe she is still waiting for Cigna to respond on that issue and the denial with my wife’s sleep study test. There is a co-worker who was denied a prescription for weight loss called Meridia that was done by express scripts, claiming it’s not covered under our policy. They removed Meridia and Xenical earlier this year without notifying anyone of changes, both medications are listed on the non-formulary list provided to us. The way everything has been going lately it appears both Cigna & Express Scripts have a problem brewing with Obesity Issues. “Discrimination” On some of the support groups that I belong to a majority of Cigna members are denied from the start which is amazing to me with Obesity issues being one of the top five health issues today. If I was only 50 pounds overweight and no medical problems, I can see this being denied, but not with 260 pounds over and with some medical issues. ($$$$$ ) My weight as of 6/24/03 has gone up to 475; the increase is due to all of the stress and having stopped smoking for just about 6 months. That’s my excuse for now.

7/2/03 A phone call to Cigna/Intracorp on the status of my appeal, my packet was assigned to a doctor on Monday. The packet was received last Thursday in Pittsburgh and must have sat around on someone’s desk for a few days or there interoffice mail services are slow. As I was talking to the representative or a nurse she was explaining to me the packets travel from the 18th of June until today. At one point in the conversation she mentioned that a request came from the satisfaction department and so forth, I just started laughing and stated that I have not seen any satisfaction and was fed up with there process. When asked how much more time it would take, her response was I don’t know it could take a couple of days or a week. I was not happy with the call and thank her for her time, thinking about the different yahoo groups I belong to I have seen Cigna employee’s being treated the same way, now that’s scary. Well until next week have a wonderful 4th of July weekend.

7/9/03 A follow-up with Cigna yesterday with no results, on hold around 40 minutes and three transfers to end up with a voice mail. I left the information they asked for and my return cell number, however no luck. I called them this morning and this time only on hold for 20-25 minutes to hear that my case is still under review. I will follow up on Friday. I start Kaplan College classes next week, I have taken 2 classes this quarter and look forward to the new challenges ahead. I returned to school last fall at a local community college and had taking 3 courses which was one to many for just returning back to school. My goal is to obtain a Bachelor of Science Degree in Business Management with emphasis in Justice Administration, which should take me about 4 years and more gray hairs. I was look forward to having my surgery before I started this new journey; however that has not happened, however I’ll continue my fight with Cigna until I get satisfaction. (NO is not an acceptable answer)

7/10/03  Cigna "Approved" the surgery today, now the wait for a new surgery date.