It's lookin' like a CigNO

[krasc001 0]

Hi All,

So I had no idea that Cigna would put up so many road blocks in order to qualify and then be accepted for the surgury. I attended my seminar this weekend and am becoming increasingly excited about this whole thing..BUT hold on. Then the nurse tells me to contact my insurance company AGAIN (I previously contacted them and obviously the guy I spoke with left something out)and this is what I find out. A number of different guidlines, most of which I don't meet will have to be met. For example...failure of medical management including evidence of activie participation within last two years in a weight management program that is supervised by physician or dietician. External programs such as WW or JC are acceptable in conjunction with being monitored by doctor.

Plus I need a psycho analysis, yada yada yada.

I can't think of one person that is my size or bigger than me that has done a supervised diet by weight watchers or jenny craig and it be monititored by a doctor. Most people just take the chance and do it themselves.

Anyway, does anybody else have CIGNA and been approved without meeting exactly all of the following?

My plan was just to get recommendation letters from my PCP because he knows my history of depression medications, family history of diabetes, high blood pressure. etc. Recommendation letters from my therapist since my biggest issue is my weight. Recommendation letters from previously seen neurosurgeon who performed my Laminectomy, letters from sports and arthritis doctor who performed cortisone injections for back, leter from previously seen nutritionist. the list goes on. I'm at a lost...

Edited October 25, 2010 by krasc001

[crecia1975 4]

Hi All,

So I had no idea that Cigna would put up so many road blocks in order to qualify and then be accepted for the surgury. I attended my seminar this weekend and am becoming increasingly excited about this whole thing..BUT hold on. Then the nurse tells me to contact my insurance company AGAIN (I previously contacted them and obviously the guy I spoke with left something out)and this is what I find out. A number of different guidlines, most of which I don't meet will have to be met. For example...failure of medical management including evidence of activie participation within last two years in a weight management program that is supervised by physician or dietician. External programs such as WW or JC are acceptable in conjunction with being monitored by doctor.

Plus I need a psycho analysis, yada yada yada.

I can't think of one person that is my size or bigger than me that has done a supervised diet by weight watchers or jenny craig and it be monititored by a doctor. Most people just take the chance and do it themselves.

Anyway, does anybody else have CIGNA and been approved without meeting exactly all of the following?

My plan was just to get recommendation letters from my PCP because he knows my history of depression medications, family history of diabetes, high blood pressure. etc. Recommendation letters from my therapist since my biggest issue is my weight. Recommendation letters from previously seen neurosurgeon who performed my Laminectomy, letters from sports and arthritis doctor who performed cortisone injections for back, leter from previously seen nutritionist. the list goes on. I'm at a lost...

I also have Cigna. They have a lot of requirements, but you must follow them. It's true that no one usually has doctor supervised weight loss attempts in the past, but you'll have to do it now to get approved. I'm not sure which Cigna plan you have, but mine required 6 months supervised diet, sleep study, therapist visit, nutritionist appointment and a letter of medical clearance from my PCP. In the beginning, I thought "hmm, why can't they just look at my medical records and see that I am fat?" There's a lot more to it and they just want to make sure you are mentally and physcally ready for this kind of surgery. I guess they want to make sure you really want this and you're ready before they pay for it. If you really want this, you will do exactly as they say. I started in March and I was banded on Oct 12th. The time will fly by before you know it.

Good Luck.

[krasc001 0]

See, that's the thing. I go to a therapist, I can get medical clearance from my doctor and bariatric surgeon but the 6mos thing?!?I don't have that much time because my insurance is about to change. I am hoping that recommendation letters stressing the need for the surgery can do the trick. So let's say I do wait 6 mos and go to a nutritionist and all this other stuff..am I supposed to fail on purpose, so I can have the surgery!! With each passing moment, I am further and further away from having this procedure. Guess I'll just be fat, depress and lonely for the rest of my life.

[crecia1975 4]

See, that's the thing. I go to a therapist, I can get medical clearance from my doctor and bariatric surgeon but the 6mos thing?!?I don't have that much time because my insurance is about to change. I am hoping that recommendation letters stressing the need for the surgery can do the trick. So let's say I do wait 6 mos and go to a nutritionist and all this other stuff..am I supposed to fail on purpose, so I can have the surgery!! With each passing moment, I am further and further away from having this procedure. Guess I'll just be fat, depress and lonely for the rest of my life.

They do not want you to fail when you do the 6 months supervised diet. I didn't do that well, but I know other people who lost weight and they were approved. Cigna goes by your beginning weight when all of the paperwork is submitted.

Don't feel like you are getting farther away from surgery. Every phone call, appointment and inquiry you make brings you one step closer. Don't feel like you will be fat the rest of your life. You are very young so you still have lots of time to get the surgery you want.

You also need to understand that the surgery is not a cure all. It can only help one aspect of your life and it will be hard work.

I hope you figure out what you want to do and I hope it all works out for you.

[honk 780]

Not to be a downer; buttt at my surgeons' info seminar they had a written statement that Cigna requires a 6 months supervised diet and there was no way around it. Also they would not speed up the process to beat changing health insurance coverage.

FYI due to health issues I ended up having to wait 8 months. Really sucked. I was devistated; two weeks before my surgery (3 months in) I got word that my surgery had to be delayed. Here's the upside. The main point of this surgery is to help you loose weight and keep it off. In those 8 months I did a lot of behavior modification and gained new habits. I had already started an excerise routine. Part of my doctors program was meeting with a Nurtionist and group sessions with a Psychologist (to discuss eating issues).

A huge part of this process is mental. If you read post op threads people talk about eating slider foods (ice cream, cake, crackers, candy). food decisions are all on you the band is not going to help you with that. During your 6 month diet you can modify your eating habits to be more healthy.

Another thing to consider is most doctors expect you to lose a certain amount of weight. Mine required at least 30 pounds. How long will it take you to loose 20-30 pounds? The more weight you lose presurgery the more you will loose overall (according to my doctor); and the safer your surgery will be.

[crecia1975 4]

Not to be a downer; buttt at my surgeons' info seminar they had a written statement that Cigna requires a 6 months supervised diet and there was no way around it. Also they would not speed up the process to beat changing health insurance coverage.

FYI due to health issues I ended up having to wait 8 months. Really sucked. I was devistated; two weeks before my surgery (3 months in) I got word that my surgery had to be delayed. Here's the upside. The main point of this surgery is to help you loose weight and keep it off. In those 8 months I did a lot of behavior modification and gained new habits. I had already started an excerise routine. Part of my doctors program was meeting with a Nurtionist and group sessions with a Psychologist (to discuss eating issues).

A huge part of this process is mental. If you read post op threads people talk about eating slider foods (ice cream, cake, crackers, candy). food decisions are all on you the band is not going to help you with that. During your 6 month diet you can modify your eating habits to be more healthy.

Another thing to consider is most doctors expect you to lose a certain amount of weight. Mine required at least 30 pounds. How long will it take you to loose 20-30 pounds? The more weight you lose presurgery the more you will loose overall (according to my doctor); and the safer your surgery will be.

honk,

You said it a lot better than me. That's what I was trying to get across. Thanks!

[krasc001 0]

Yes, I am coming to the conclusion that I have to do this whole six month thing. But I am going to submit what can submit now and see what happens. I have absolutely nothing to lose. I just want to get it done now..waiting is a bitch and given my track record, I'm not going to magically turn into a caloring counting, Denise Austin overnight. The thing for me is, I shouldn't have to lose weight before surgery so I don't need to worry about that. But the six month thing...DAMN!!!!!

[krasc001 0]

Let's be honest, I'm out of energy, I'm out of options and I'm almost out of time. Not that I'm like 280 lbs or higher but I could still stand to lose 100lbs. I'm just sick of being fat and stiff and unhealthy. I do understand that the band just can't work alone, that you have to do your part. Health insurance companies put these guidelines in place to change your mind, its starting to work. This battle in unwinnable. Thanks for your advice though.

They do not want you to fail when you do the 6 months supervised diet. I didn't do that well, but I know other people who lost weight and they were approved. Cigna goes by your beginning weight when all of the paperwork is submitted.

Don't feel like you are getting farther away from surgery. Every phone call, appointment and inquiry you make brings you one step closer. Don't feel like you will be fat the rest of your life. You are very young so you still have lots of time to get the surgery you want.

You also need to understand that the surgery is not a cure all. It can only help one aspect of your life and it will be hard work.

I hope you figure out what you want to do and I hope it all works out for you.

[honk 780]

They are putting you through hoops. No denying that. All the hoops I had to jump through are part of the arguement that this is not a quick fix. If it were I would have gone to the doctor on 12/28/09 and had surgery a week later. Instead I did not have the procedure until 8/13/10. In that 8 months I lost 52 pounds.

[sassysue 0]

I have been there with Cigna and have fought the fight. I was very hard and I wanted to give up but they made me mad with all the hoop la and so I fought harder. Hang in there and keep fighting. It is worth it in the long run. I was banded the first of June and have lost 40lbs.

[kfields 0]

I also have Cigna. my plan also required 6 months supervised diet, sleep study, therapist visit, nutritionist appointment and a letter of medical clearance from my PCP. It took about 4-6 weeks to hear back but I did get approved. I will be banded on 11/3. Hang in there it will work out for you.

[Jess55 97]

I don't think there is any way to bypass the 6 month medically supervised diet. I had done 6 months of WW within the last year and at the seminar they stated that this would suffice for those requirements, so here I was thinking, great I can have my surgery after I am done with all the tests. Well 2 months later, I got some news that devastated me, that was no longer sufficient, and I would have to continue to do the 6 months, I already had 2 months under my belt, but still I was so upset. So I moped for a bit, then I got over it and said, ok, I will have to deal. So I have my 5th weigh in this week, my 6th next month and will hopefully be banded mid december. So just do it, you will be happier in the long run.

[Sooverit! 1]

Ha ha I love that Cigno.....i was a in a Cigno place a few years ago...no matter what hoops I jumped through or rules I followed they weren't budging on covering the band. They never did but I found a low BMI study I was a 35 BMI and it was discounted. whew...I would be very overweight now! After 50 lbs. lost on the band I can say I like CIGNA again. They have covered every single proceedure I've had since then and are considered the darling of insurance companies by the docs. go figure!