Cigna Help needed

[Barbara266 0]

I have been obese most of my life, I have a BMI of 40 and after a year of researching I have decided to have the LAP Band. I already have attended my seminars, nutrionist, nurse practioner, psyc doc and I have been seeing my doctor for about a year. Unfortunately, I have only seen her every 3 months, now they tell me the Insurance Company may require I see her every month for 6 months. Someone please give me advice about how I can get a round this.:think I am so disappointed to have to wait another 6 months and still not know for sure if they will cover me. Please advise.

[mrlddst 0]

Hey I have Cigna as well and I was approved. I think you should talk to you PCP or NP and see if they would be willing to back log your records with phone conferences or visits. If you think he/she would go for it, provide some kind of record to them showing how much you wieghed that month, what your eating habits were and what kind of exercise you did. It would make life alot easier for them. Also provide a letter that details all of your efforts including monthly weights and have her add any info she can. If you need an example, let me know.

Good luck!

[Barbara266 0]

Thank you for the advice I will contact my doc tomorrow! I will let you know how it turns out.

[Thinjen 0]

"Back logging" records is insurance fraud. Good luck with that.

[mrlddst 0]

Like I said see what you doc says..... If YOU know what your weight, exercise methods and dietary instructions for each month, then send them to your doc. They should correspond to the letter of necessity that your doc needs to send in with your other paper work. Draft all of these items and send them to him/her. I've found that the more you accomodate them, the easier it is for them to help you.

"It never hurts to ask, the worse they could say is no." Believe me Cigna wants that 6-mos done by your PCP, no doubts about that one, so either ask or start meeting with your doc. And if you go to meet with the doc for weigh-ins, make sure you go in be seen for something else and then have your weigh-in done. For example, be seen to check on you blood pressure every month and get your weight checked, nutritional advice, and exercise stuff.

[Shelby 0]

I also have Cigna as well and was denied because my surgeons office forgot to include my 6 month PCP report. Now I'm denied again from my 1st appeal -- just waiting for the letter to find out what the reason is for this denial. Cigna couldn't tell me over the phone. It's all very frustrating but don't give up! Go monthly to your PCP -- time flies and before you know it you would have completed your 6 month requirement.

[shackdog 1]

I have cigna and am pre-op they have denied me because of a writer my company has saying that weight surgery is cosmetic, and no matter what the doc writes they will not give. I contacted an attorney and he told them that when I die from the weight then my estate will sue for wrongful death. that still did not work, I am self pay and am set to be banded on the 17 april.

[Barbara266 0]

Well, the doctor was willing to add all of my weigh ins to the notes, hopefully it will be good enough for the insurance company. The Center for Obese Surgery that I am dealing with is wonderful, they do everything for you. I filled out a complete patient profile that answers all of the questions that most insurance companies ask. They seem to have an extremely high success rate with getting insurance carriers to cover. After reading all of the horror stories about coverage I am hoping they are just as successful with mine. Right now the NP is reviewing my file to see if all is in order before it goes off to Cigna, if so they usually here back form them within a few days. So please, wish me luck!

[mrlddst 0]

Well I glad that everything worked out! Let me know how it goes.

[Angels 0]

That is the same requirement for my ins co MDIPA, United Healthcare. However, the good news is they accepted my Weight Watcher records of more than 6 consecutive months. Thank GOD, I did not have to wait until August 2006.

[Angels 0]

Your doctor could definately lose his license and I know he/she is not willing to do that. My doctor told me that specifically without even asking him to do such a thing. However, my Weight Watcher records were accepted since it was for more than 6 consecutive months.

[Barbara266 0]

I don't think she has to worry about losing her license. Cigna requires every conversation, weigh in etc. be documented, she was unaware that was required. Therefore, she had to go back into the memory bank and document our conversations. Thank God I have a journal that she made me keep of all of my weights. We just needed to put it all down on paper so that it could be submitted. Anyway, the NP has approved all paper work and has givien me a tenative date of April 18th. Just waiting on good ole CIGNA.

[Constance 0]

My PCP has told me we will need to combine my personal records with her records before we submit the info to Cigna. I, too, was only seeing her every 2 or 3 months. I'd like to know your ideas and feedback on this if anyone has suggestions. I hate to just sit in her office guessing at what to write. All I can say is that I gained and lost the same 5 pounds for 6 months. Is that what Cigna is looking for?

[Barbara266 0]

Well, this is what I have learned. My doctor did document the visits and the weights and we submitted it. However, it was denied. What they requested was more detail. It should state on each visit that the patient was counceled on diet and exercise, and continues with the plan, the weight should also be listed. You will need 6 months of this. They also requested documentation from the past 5 years to prove that I have been overweight for a long time. We have re-submitted it and my NP is doing a Peer to Peer today, wish me luck I will let you know how it goes.

[Mystyblu 0]

I have Aetna insurance and they require the same 6 months documentation. Luckly my PCP uses a laptop for all of our visites so it was easy for her to keep track of our visits.