:grumble: FRUSTRATED!! Received a letter from my insurance today: "we are unable to substantiate medical necessity for laparoscopic sleeve gastrectomy"

Per the policy below, I met all the requirements.My BMI alone is high enough, plus I had the physician supervised medical diet, the NUT, the psyc eval, and the PCP recommendation ........

Cigna covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met:
The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:
 a BMI (Body Mass Index) ≥ 40
 a BMI (Body Mass Index) 35–39.9 with at least one clinically significant obesity-related comorbidity, including but not limited to the following:
o mechanical arthropathy in a weight-bearing joint
o type 2 diabetes mellitus
o poorly controlled hypertension (systolic blood pressure at least 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite optimal medical management)
o hyperlipidemia
o coronary artery disease o lower extremity lymphatic or venous obstruction
o obstructive sleep apnea o pulmonary hypertension
• Medical management including evidence of active participation within the last 12 months in a weight- management program that is supervised either by a physician or a registered dietician for a minimum of three consecutive months. The weight-management program must include monthly documentation of ALL of the following components:
 weight
 current dietary program
 physical activity (e.g., exercise program) Programs such as Weight Watchers®, Jenny Craig® and Optifast® are acceptable alternatives if done in conjunction with the supervision of a physician or registered dietician and detailed documentation of participation is available for review. However, physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.
• A thorough multidisciplinary evaluation within the previous six months which includes ALL of the following:
 an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes
 a separate medical evaluation from a physician other than the requesting surgeon that includes both a recommendation for bariatric surgery as well as a medical clearance for surgery
 unequivocal clearance for bariatric surgery by a mental health provider
 a nutritional evaluation by a physician or registered dietician