By Alan Ray LBHR with Dr. De Smet 12/15/2004
THE APPEAL LETTER TO CIGNA (NAU IS "national appeals unit")
Dear CIGNA NAU:
I have received your written notice, dated Aug. 27, 2004, denying my initial request for pre-authorization for left hip surface arthroplasty. With this letter and attachments, the request is being re-submitted for further consideration as an appeal of the initial denial.
I am a 55-year-old male diagnosed in March of this year with end-stage osteoarthritis of the left hip, with “some component of dysplasia”. The result of the condition is that I am unable to engage in the athletic activities that have helped me control hypertension and maintain extremely low blood cholesterol levels (as demonstrated in my past two annual
physicals). Despite a high-stress professional position and extremely demanding work schedules, I have managed to maintain my health…with the help of competitive handball, three to four times a week, and a rigorous regime of weight-resistance training, and aerobic conditioning. Now the activities that helped keep me healthy are closed to me.
The physician who provided the initial diagnosis also made clear that, with a Total Hip Replacement, these activities would be closed to me for as long as I live. With that word from him, I set out to find an alternative.
It is clear, from what I have read in the professional literature that, with a Total Hip Replacement, in addition to a high level of surgical and post-operative complications, there is an exceedingly high likelihood of dislocation in even basic activities…