sher0929

Anyone approved by Cigna recently? My surgeon's coordinator just submitted my info to Cigna today and I'm SO nervous! She told me that denials don't happen often and they are usually able to overturn them if they do. She even gave me a surgery date already. April 24th! I met all of the requirements and I know the team knows what insurance companies look for. Just can't help but freak out a little! The last few months have been crazy and it would suck to be denied when I'm finally almost at the finish line. I'm curious to hear recent experiences with Cigna. It seems most of the topics I find on here about Cigna are from a while ago.

Approved!! 🤩 My surgeon submitted paperwork to Cigna on Thursday afternoon and I received my approval Monday evening. I'm impressed with how quickly it was approved. I even received a letter yesterday stating that Cigna needed more information (it clarified that the letter was not a denial, just a request for additional records). Here is a recap of my insurance approval process for anyone who is curious how it went: Surgeon - Alisa Coker Johns Hopkins Bayview Baltimore, Maryland SW: 192 Height: 5'0 BMI: 37.5 Procedure: Laparoscopic Sleeve Gastrectomy (aka sleeve or gastric sleeve) Comorbidities: Diabetes, Hyperlipidemia (High Cholesterol), Hypertension (High Blood Pressure) **Worth noting, I take one medication for diabetes, and one low dose medication for hypertension. The hypertension medication I actually stated taking during this process.** Requirements- BMI = or >40 or = or > 35 with at least one comorbidity 3 Months of medically managed weight loss with primary care or registered nutritionist/dietitian (4 visits total - first was Dec 5th and then one each month Jan, Feb, March) **I have since read the verbiage change in Cigna's requirements and they have removed the 3 months of supervised weight loss. This may still me a requirement by your surgery team though, but it doesn't hurt to ask** Upper Endoscopy - Standard test that checks for GERD, stomach ulcers, infections, and anatomy. This was an outpatient procedure. I was in the hospital for a total of 3 hours from arrival to departure. I was completely asleep during the procedure (they give you a top shelf iv cocktail) but recovery was much less than that of general anesthesia. Sleep Study - For sleep apnea and/or other weight related sleep disorders. Mine was an at-home test that was easy as pie. It was a wrist watch that connected to a few nodes and a sensor on your finger. Psychological Evaluation - I went to a doctor who specializes in evaluations for bariatric surgery. It was probably the most nerve wracking of all the appointments because there's a strange looming in the air that these evals are hard to pass. **Tip - Tell the truth (your insurance will look at your medical records so if you have been treated for mental health but lie about it during your eval, they may deny you coverage) but don't unload your whole tragic life story on them. I have been treated for and hospitalized for bipolar and it didn't prevent my approval. They are basically trying to determine if you have a clear understanding of what the surgical procedure is and how your lifestyle will need to change. They want to make sure there isn't anything major that will intellectually challenged your results (major or unaddressed eating disorders, lack of understanding of the diet requirements, lack of motivation to lose weight), that you have a good support system at home, and that you are aware of aftercare requirements for life, possible complications, and after affects of weight loss on yourself and your relationships. In a nutshell, they need to know that you're aware of what you're getting yourself into, you are of sound mind, it was your decision to have surgery (not having the procedure against your will or at someone else's insistence), and you are equipped with the knowledge you need to be successful afterwards. Nutrition Consultation - I was required to see the nutrition team at Johns Hopkins for a 90-minute appointment. We covered every aspect of the diet requirements from the two week pre-op, day before surgery, day of surgery, and each week after surgery until the 8 week mark. This appointment was very helpful. It was the most important component, in my opinion, because it really showed me exactly how my diet and lifestyle would change. I left that appointment with zero questions about how to be successful. Letter Of Recommendation - A letter from my primary doctor (it had to be a doctor unaffiliated with the surgeon or surgeon's team) stating that I was physically able to have surgery, that I failed to maintain weight loss via medically assisted management, and that weight loss surgery was being recommended and was medically neccessary. This letter is very important as I have heard/read stories about insurance denials because the verbiage wasn't correct or one of the listed components wasn't included. Blood Work - Usually done by primary care. This served as proof of hyperlipidemia and diabetes. Once all of these were completed and the surgeon's coordinator received the paperwork, she compiled it into a package for review. She handed it over to a nurse on staff who double checks that everything is there and that it is in the right format with the right info. **Most surgical teams are well informed about what insurance companies look for. They will make sure your information is submitted correctly to prevent delays and denials.** Once the nurse gave her seal of approval, the coordinator submitted the precertification request to Cigna on Thursday. Monday afternoon I received a letter that said additional information was being requested from my surgeon. I contacted Cigna to find out what additional info was needed (I was curious...and antsy!) They told me that the surgeon would receive a letter as well which would include details of the request. Well, that didn't satisfy me so I probed on asking if those details could be disclosed to me, since it is MY medical record. The Cigna rep (Charline) was extremely helpful. She contacted the precertification department for details and called me back that evening with news that I was approved. Johns Hopkins had provided the requested information pretty much immediately upon receiving the request. Low and behold, I checked my myCigna account and the black, in-progress status had transformed into the prettiest green APPROVED:) Big props to Marie Day and the team at John's Hopkins for their attentiveness!!! And that, my friends, is the super drawn out, nitty gritty process of getting approved for bariatric surgery via Cigna! I know when I first set out I had a million questions so I tried to provide all of the info I always looked for but couldn't find. If you have any specific questions for me please let me know. I'm not a medical professional, this is simply info from personal experience, but I'm happy to offer peace of mind if I can! Happy sleeving, y'all!

I am on day 10 post op and I am not losing any weight at all. I don't get it! I was sleeved Friday April 26th. The following Tuesday April 30th I was 7 pounds down from the day of surgery. I have weighed the SAME EXACT THING since then! I am following the diet to a T, sometimes not even hitting my calorie goal, averaging a little less than 500 calories per day 60 grams of protein, and the scale isn't budging. What gives? How can someone eat so little and not lose even .1 of a pound? Tomorrow it will be one week of zero weight loss. I'm beyond discouraged right now. Anyone else experience anything similar? Do I just need to give it time? I could cry! :(

haha!!! thank you so much!!! 🙂

Thank you! Hearing encouraging words definitely helps! I know I'm being impatient. Might have to kick the scale to the curb for a few weeks and stop stressing over it. So hard to do though! lol

Sooo I'm 3 days post op and still struggling with determining when I'm full or not. Every time I swallow a sip of anything, I feel tightness just below my sternum. In between trying to drink my protein supplements my stomach growls as if I am hungry (the feeling of hunger pre op). I know I have to learn to recognize the new full feeling, but it seems like I can't settle into a routine of how much to eat (or drink, I'm still full liquid), when to stop, or if I'm feeling hungry. There have been a few times where I took a sip to take meds and I immediately begin heaving but never actually throw up. That in itself is scary too because I'm worried about my incisions splitting or something. Any advice for a fresh sleever?? Thanks! Sherry Sherry

Thank you all so much for your advice! I think my sips are definitely too large and I'm trying to consume too much at once. I actually just got a check in call from the nurse and she said that having a bowel movement may help relieve some pressure as well. Which I haven't had since the day before surgery. So Miralax it is! (sorry if it's tmi but we all gotta deal with it, right?)

@KarenLR75 I'm sorry I'm just now getting back to you! Cigna required 3 months of consecutive medically managed weight loss appointments that could be done with either your primary care physician or a registered dietitian/nutritionist. It was four visits all together. Cigna recently changed it's policy though and they removed the 3 months of appointments requirement. As far as Cigna insurance approval goes, you just need a letter from your doctor recommending you for surgery, stating that you have tried and failed to maintain weight loss in the past, and clearing you physically for surgery. There are a few other things you've gotta do for them to approve you but there is nothing in the new verbiage that states you have to have a specific number of monthly visits. You can check the Cigna website or google Cigna bariatric surgery requirements and you should find a pdf that outlines it all. I know some surgeon's offices have their own set of requirements in addition to the ones required by insurance. I have heard that some surgeon's require 6 months of appointments and a certain amount of weight loss prior to prove that you are mentally ready for surgery and are able to be disciplined. Since the surgery is just a tool, they want to make sure when they perform the surgery, the patient is going to follow through on their end. If I were you, I'd get a copy of Cigna's bariatric surgery requirements for approval and then speak with your surgeon's office to figure out what is required by them outside of Cigna's requirements. Sorry that was long winded! Hopefully helpful though!

I just got my date...April 24th! Ahh! I finally feel like this is real. So ready!

Thank you everyone! I actually ended up finding a psychologist with a freak opening lol so I had my eval :)

Hi ya'll! This is my very first post but I've been reading through the forums for a few weeks now. I am having trouble finding a provider to do my psych evaluation. I am having surgery with Dr. Alisa Coker at Johns Hopkins Bayview (and the experience has been wonderful thus far), but the psychologists they work with are scheduling into June or July of this year. I spoke with Dr. Coker's coordinator and she said that I am not limited to those providers specifically, I just needed to make sure it was a psychologist or psychiatrist who is able to perform bariatric surgery evaluations. All of my pre-reqs for insurance will be completed by the second week of March with the exception of the psych eval. I really don't want to have to wait 3 or 4 additional months, so I am trying to find somewhere else in MD or even southern PA who is able to provide these evaluations. Does anyone have recommendations for somewhere else I can go? I'm willing to take a long drive if I have to lol Any suggestions of providers/practices would be MUCH appreciated.