Borderline BMI with CIGNA 6 mo dr supervision req

[BeachBreeze2010 0]

I have CIGNA as my insurance carrier, so I have the 6 month requirement to go to weight loss classes under a physician's supervision. While this is a bummer because I really want to get going with the lap band surgery and not wait 6 months, I have an additional concern. I am exactly at a BMI of 40. If I lose so much as 10lbs, I won't qualify for the lap band. I am sure I could go to a 6 month supervised clinic and lose 15lbs - and then regain it as soon as I stopped. Or keep it off and continue to struggle being 85lbs overweight instead of 100. Sure, I would love to go to a 6 month thing and lose 50#s and not have to have the lap band, but I've lost 50lbs before only to regain it. It wasn't physician supervised, though so I don't think it counts for CIGNA.

I also am unsure of what I have to do to have it count as 6 months supervised. The university hospital has a 6 month program (in the same division as the bariatric surgery program), but it costs $1,000. And of course, CIGNA doesn't cover it. I feel so stuck. I really thought the Lap Band was going to be an option for me, but now I feel like more roadblocks are up in my way. I am not trying to be a size 4, just to be "normal." I want to wear clothes from normal stores, to be able to spend the day at the zoo or shopping mall without having my feet and knees hurt for days afterwards, to sit on the bleachers and watch my daughters' games and not have my back kill me because I don't really fit on it, and on and on.

Does anyone have any advice?

[CIGNAQuestions 0]

I understand your situation and would like to help, email me @ SCR_isolve@cigna.com, I'll look into your options on our side.

[readyinTN 0]

I'm in a similar situation with Cigna. However, my BMI is a 36 and I have been supervised for almost 2 years but I have had 3 gaps that were 60 days and my doctor will not submit because he is 100% sure that they will deny it. Your physician will want you to try and loose weight prior to surgury so go ahead and get started. The 6 months will go by quickly!

[katwomantexas 2]

I have CIGNA as my insurance carrier, so I have the 6 month requirement to go to weight loss classes under a physician's supervision. While this is a bummer because I really want to get going with the lap band surgery and not wait 6 months, I have an additional concern. I am exactly at a BMI of 40. If I lose so much as 10lbs, I won't qualify for the lap band. I am sure I could go to a 6 month supervised clinic and lose 15lbs - and then regain it as soon as I stopped. Or keep it off and continue to struggle being 85lbs overweight instead of 100. Sure, I would love to go to a 6 month thing and lose 50#s and not have to have the lap band, but I've lost 50lbs before only to regain it. It wasn't physician supervised, though so I don't think it counts for CIGNA.

I also am unsure of what I have to do to have it count as 6 months supervised. The university hospital has a 6 month program (in the same division as the bariatric surgery program), but it costs $1,000. And of course, CIGNA doesn't cover it. I feel so stuck. I really thought the Lap Band was going to be an option for me, but now I feel like more roadblocks are up in my way. I am not trying to be a size 4, just to be "normal." I want to wear clothes from normal stores, to be able to spend the day at the zoo or shopping mall without having my feet and knees hurt for days afterwards, to sit on the bleachers and watch my daughters' games and not have my back kill me because I don't really fit on it, and on and on.

Does anyone have any advice?

I have Cigna also and just had my surgery. My BMI is a 35 with the high blood pressure and all.

Any questions just ask.

Katwomantx

[samnic 0]

Hi There,

I am in the same exact situation. I too have a BMI of exactly 40 and have to participate with a 6 month supervised diet. I started in march. I basically can not lose any weight, although I was recently diagnosed with High BP so the physician said I could go down to a BMI of 35 but I choose not to do that. It sounds crazy but I dont want anything to jepordize me qualifying for this surgery. I too have lost 40 lbs about 4 years ago and havve once again gained it back. I just want this process to be over already. I am ready to begin a new life, that is pain free-(without knee pain). I dont think the insurance company will deny you if you dont lose any weight. Let me know if you find any more information about this. Good luck!

I have CIGNA as my insurance carrier, so I have the 6 month requirement to go to weight loss classes under a physician's supervision. While this is a bummer because I really want to get going with the lap band surgery and not wait 6 months, I have an additional concern. I am exactly at a BMI of 40. If I lose so much as 10lbs, I won't qualify for the lap band. I am sure I could go to a 6 month supervised clinic and lose 15lbs - and then regain it as soon as I stopped. Or keep it off and continue to struggle being 85lbs overweight instead of 100. Sure, I would love to go to a 6 month thing and lose 50#s and not have to have the lap band, but I've lost 50lbs before only to regain it. It wasn't physician supervised, though so I don't think it counts for CIGNA.

I also am unsure of what I have to do to have it count as 6 months supervised. The university hospital has a 6 month program (in the same division as the bariatric surgery program), but it costs $1,000. And of course, CIGNA doesn't cover it. I feel so stuck. I really thought the Lap Band was going to be an option for me, but now I feel like more roadblocks are up in my way. I am not trying to be a size 4, just to be "normal." I want to wear clothes from normal stores, to be able to spend the day at the zoo or shopping mall without having my feet and knees hurt for days afterwards, to sit on the bleachers and watch my daughters' games and not have my back kill me because I don't really fit on it, and on and on.

Does anyone have any advice?

[Fee1970 0]

I too am with Cigna...it is my understanding that whether you lose weight or not is irrevelant, because the weight and the BMI that they go by is what you weighed when you met with the surgeon. I have to wait the 6mos as well. I have scheduled my nutritionist appt and psy eval, it is my understanding that it will be covered, (for me) Be sure to double check with Cigna or have the doctor where you schedule to check to make sure it is applicable to you. It is a bummer about the six months, but I am trying to get my appointments and stuff started and maybe try to submit in 4 and see what happens. Good luck.

[DRB1 0]

I have CIGNA as my insurance carrier, so I have the 6 month requirement to go to weight loss classes under a physician's supervision. While this is a bummer because I really want to get going with the lap band surgery and not wait 6 months, I have an additional concern. I am exactly at a BMI of 40. If I lose so much as 10lbs, I won't qualify for the lap band. I am sure I could go to a 6 month supervised clinic and lose 15lbs - and then regain it as soon as I stopped. Or keep it off and continue to struggle being 85lbs overweight instead of 100. Sure, I would love to go to a 6 month thing and lose 50#s and not have to have the lap band, but I've lost 50lbs before only to regain it. It wasn't physician supervised, though so I don't think it counts for CIGNA.

I also am unsure of what I have to do to have it count as 6 months supervised. The university hospital has a 6 month program (in the same division as the bariatric surgery program), but it costs $1,000. And of course, CIGNA doesn't cover it. I feel so stuck. I really thought the Lap Band was going to be an option for me, but now I feel like more roadblocks are up in my way. I am not trying to be a size 4, just to be "normal." I want to wear clothes from normal stores, to be able to spend the day at the zoo or shopping mall without having my feet and knees hurt for days afterwards, to sit on the bleachers and watch my daughters' games and not have my back kill me because I don't really fit on it, and on and on.

Does anyone have any advice?

I had Cigna too. They count the weight and BMI at the start of the process -- not after 6 months of weight loss. It is true that they don't pay for visits with the nutritionist for weight loss purposes. But they will pay once your surgery is approved. My doctor had me pay one invoice and held the rest until I was approved. Insurance paid for all of it and I got the money back from the initial invoice. Be patient. The 6 month waiting period is a great time for getting your head together about the lifelong changes that will occur once you become a "bandster". Good luck with your journey!

[DrHekier 0]

First of all, remember that one person's Cigna may be different than another. Having said that, in our practice, we have found that nearly all insurance companies go by the BMI at the time of the first evaluation by the bariatric surgeon, so you should be fine. Do the best you can on the 6 month program to lose all the weight you can. The healthier you are going into the surgery, the more likely you will have a speedy recovery and a safe outcome. Good luck!

[shonette 9]

I have CIGNA as my insurance carrier, so I have the 6 month requirement to go to weight loss classes under a physician's supervision. While this is a bummer because I really want to get going with the lap band surgery and not wait 6 months, I have an additional concern. I am exactly at a BMI of 40. If I lose so much as 10lbs, I won't qualify for the lap band. I am sure I could go to a 6 month supervised clinic and lose 15lbs - and then regain it as soon as I stopped. Or keep it off and continue to struggle being 85lbs overweight instead of 100. Sure, I would love to go to a 6 month thing and lose 50#s and not have to have the lap band, but I've lost 50lbs before only to regain it. It wasn't physician supervised, though so I don't think it counts for CIGNA.

I also am unsure of what I have to do to have it count as 6 months supervised. The university hospital has a 6 month program (in the same division as the bariatric surgery program), but it costs $1,000. And of course, CIGNA doesn't cover it. I feel so stuck. I really thought the Lap Band was going to be an option for me, but now I feel like more roadblocks are up in my way. I am not trying to be a size 4, just to be "normal." I want to wear clothes from normal stores, to be able to spend the day at the zoo or shopping mall without having my feet and knees hurt for days afterwards, to sit on the bleachers and watch my daughters' games and not have my back kill me because I don't really fit on it, and on and on.

Does anyone have any advice?

My insurance was with Cigna as well and the only weight and BMI they considered was the one at my initial visit with the surgeron. He actually encouraged me to lose as much weight as possible during my 6 month documented weight lose visits. He stated it would only help me in the long run with having my surgery. I just did my weight lose supervised visits with my family doctor. Every cigna plan is a little different but I looked up on the internet about Cigna's weight lost surgery requirements, and the 6 month supervised period most likely will not be waived. (I tried to summit my paper work early and -yes, I was denied) However, after that time frame was fulfilled my surgeron was given approval within that week. He only did his lapbands every 2nd & 4th Wednesday of the month, therefore, I had to wait for one of those times. Most people don't like to hear this, but that 6 months is a good time to read, read as much as possible about having a band and adjusting to the life style changes that you will have to make. I promise you there are a lot of them. Having a band is not an easy fix, but adjusting to a permant barrier to miminize your food intake.

Good luck!

[TDTNIKKI 0]

I have cigna and its waiting on approval my bmi is 35.4 but my problem has not been with cigna yet its with the Lap Band office they are awful I really don't think I will be approved even tho I have sleep apnea and hypothridisim its worse than anything I have ever been through and I haven't even had to deal with cigna,becarefull who you chose to go through to do it ,it can be the difference between yes and no

[Alli in StL 23]

I would think that if you're already having problems with the office and you haven't even been approved yet, you should be looking for a different doctor.

I have cigna and its waiting on approval my bmi is 35.4 but my problem has not been with cigna yet its with the Lap Band office they are awful I really don't think I will be approved even tho I have sleep apnea and hypothridisim its worse than anything I have ever been through and I haven't even had to deal with cigna,becarefull who you chose to go through to do it ,it can be the difference between yes and no