Cigna Requirements For Vsg Surgery

[wannabeskinny 0]

So I've completed all the requirements for VSG by my insurance company and my doctor's office submitted my paperwork. I was denied due to not having a letter of clearance by my PCP. Okay, no big deal. I went to my pcp and he wrote the letter and forwarded it to my surgeons office. I follow up with the surgeons office on Thursday to find out if my paperwork has been resubmitted and the coordinator states that after further review CIGNA requires a BMI of 50 for VSG. I'm like WTF? That's not why I was denied. She then states there is a clause they noticed and called the insurance company to verify. The coordinator said she spoke with a supervisor at CIGNA and that a 50 BMI is required. WTH is going on? I was told a 40 BMI or over 35 BMI with a comorbidity by their office and the insurance company. The coordinator states that I would be approved for the lap band or the bypass. I DON'T WANT EITHER OF THOSE!!!

So i'm so confused now! The denial letter states that I am being denied because of a clearance letter and not because my BMI is too low. Wouldn't the insurance company have denied because of the BMI requirement not being met if that was the issue? Should I have my doc's office resubmit the paperwork with the clearance letter and hope somehow they miss the part that I only have a BMI of 40 with acid refux and mild sleep apnea? Evidently this will be my last chance to submit paperwork for this surgery since I have already been denied once. Not sure how that whole thing works, but that's what a CIGNA agent told me. I can only submit one more time.

Has anyone been approved by CIGNA for VSG with a 40 BMI? :help:

[Guest Roz1967]

I am so sorry about your situation. That doesn't sound right to me either. The BMI requirement for CIGNA is 40! http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdfis.......

Read this. These are the requirements for Bariatric surgery for CIGNA. Your denial had to be for the aforementioned reasons not because of your BMI. Be encouraged!!!

[Krystle 2]

So I've completed all the requirements for VSG by my insurance company and my doctor's office submitted my paperwork. I was denied due to not having a letter of clearance by my PCP. Okay, no big deal. I went to my pcp and he wrote the letter and forwarded it to my surgeons office. I follow up with the surgeons office on Thursday to find out if my paperwork has been resubmitted and the coordinator states that after further review CIGNA requires a BMI of 50 for VSG. I'm like WTF? That's not why I was denied. She then states there is a clause they noticed and called the insurance company to verify. The coordinator said she spoke with a supervisor at CIGNA and that a 50 BMI is required. WTH is going on? I was told a 40 BMI or over 35 BMI with a comorbidity by their office and the insurance company. The coordinator states that I would be approved for the lap band or the bypass. I DON'T WANT EITHER OF THOSE!!!

So i'm so confused now! The denial letter states that I am being denied because of a clearance letter and not because my BMI is too low. Wouldn't the insurance company have denied because of the BMI requirement not being met if that was the issue? Should I have my doc's office resubmit the paperwork with the clearance letter and hope somehow they miss the part that I only have a BMI of 40 with acid refux and mild sleep apnea? Evidently this will be my last chance to submit paperwork for this surgery since I have already been denied once. Not sure how that whole thing works, but that's what a CIGNA agent told me. I can only submit one more time.

Has anyone been approved by CIGNA for VSG with a 40 BMI? :help:

I have CIGNA and I am almost 2 weeks post op for VSG. There's a lot to do for cigna to get approved. But they do cover the sleeve by itself as a surgery. Here is the cigna medical policy for weight loss surgery. http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf I would print a copy of that off and take it to your surgeon's coordinator and explain to her that a BMI of 40 qualifys you for surgery. Per cigna's guidelines you must have a BMI over 50 to get a DS sugery not a VSG. So you can get approved. You can also call cigna and resubmit the authorization yourself with the proper paperwork. When you call cigna make sure that you listen to the prompts for the authorixation department. There will be a refference number, write that down. That number is what the surgeon needs to bill cigna and get paid. Your BMI is fine. The coordinator needs to resubmit. But also make sure that the place that the surgeon is going to preform the surgery is a center of excellance by cigna if it's not you will get denied again. I hope this helps. Add me as a friend and you can ask me any questions in regards to cigna or insurance. I am a medical biller so I work with insurance all the time. Hope you can get this going for you. Have a great weekeend!

[HunnyBunny 5]

well see i had lap band and now want sleeve my lap band was removed in febuary and now i want to have sleeve and my insurance denied and it makes not sense

[FloraBama Girl 116]

I had Cigna *** and it covered my surgery. I had a BMI of 42.5 when the paperwork was submitted, I got the approval on Monday August 22 and had surgery Auguest 24. The approval for the surgery was all we were waiting on because all the other requirements had been meet. Here is an a passage from the Cigna policy:

CIGNA covers bariatric surgery using a covered procedure outlined below as medically necessary when ALL of the following criteria are met:

• The individual is ≥ 18 years of age or has reached full expected skeletal growth AND has evidence of EITHER of the following:

???? a BMI (Body Mass Index) ≥ 40

???? a BMI (Body Mass Index) 35–39.9 with at least one clinically significant obesity-related comorbidity,

Also your surgeon must recommend the surgery and gives them the CPT Codes for the sleeve procedure. I had the codes for Morbid Obesity and Sleeve Gastrectomy in the letter of medical necessity from PCP. The only problem I had was Cigna had asked the surgeon' office for their clinical notes on me and there was some confusion on whether Cigan was going to calll or not. Cigna finally sent a fax and when the information had been provided I got approved in 2 days.

[wannabeskinny 0]

My surgeon's office resubmitted my paperwork last Monday so I'm anxiously awaiting the response. I've thought about calling Cigna several times, but I'm afraid I'm denied so I haven't gotten up the courage to call yet. lol

[Krystle 2]

My surgeon's office resubmitted my paperwork last Monday so I'm anxiously awaiting the response. I've thought about calling Cigna several times, but I'm afraid I'm denied so I haven't gotten up the courage to call yet. lol

Just be positiive. You can also have someone else call. As long as they are right there with you, they can ask the representative the questions with your permission. And than you jus tlisten. They are really quit friendly. If you have anymore questions just let me know. Stay positive. You should have a answer on your authorization with maxium 5 business days. Unless they need something in return. Just make sure that you write the persons name down when you call and what time and day, also a breif summary of what the converstation was about so you have some documentation.

[wannabeskinny 0]

So I checked with my surgeon's office and they said they had to refax my paperwork because Cigna doesn't have any record of receiving it. Grrrrrrrr So frustrated! Thanks for the informaion! I'll definitely document our convo next week when I call Cigna!

[Krystle 2]

So I checked with my surgeon's office and they said they had to refax my paperwork because Cigna doesn't have any record of receiving it. Grrrrrrrr So frustrated! Thanks for the informaion! I'll definitely document our convo next week when I call Cigna!

Yea that can happen sometimes with the insurance company. It really sucks. But it once CIGNA get's it than they are normally pretty quick on getting you approved. If you have met all the qualifiers than you are automatically approved. Just hang in there. But Cigna is a good insurance to have. They are really awesome. But here's one thing to waatch out for with your nausea meds. When I left the hospital I had a perscription for 30 8mg zopfran disolveable pills. I went through those in 5 days, which was what the perscripton was wrote for. They gave me the generic version of zopfran which is ondansatron. But anyways, I call my surgeron on friday for a refill and on saturday when I call to pick it up cigna had denied the refill. They denied it sayin they need a authorization for the refill and will only pay this time for 20 pills. So I saw my surgeon today and asked him to call. They got the auth in and cigna paid for them but my surgeon forgot to write it for desolvables. So I have to crush them up, they are soooo icky to drink .But I am calling tomorrow to request for disolveables becuase I can't take them like this they are way too gross. So something to watch out for for your medications. But I didn't have to pay for any of my meds, cigna for me paid at 100%. So meet your deductibles. Than they will pay 100%. Hang in there.

[crossviewcutie11 7]

Yea that can happen sometimes with the insurance company. It really sucks. But it once CIGNA get's it than they are normally pretty quick on getting you approved. If you have met all the qualifiers than you are automatically approved. Just hang in there. But Cigna is a good insurance to have. They are really awesome. But here's one thing to waatch out for with your nausea meds. When I left the hospital I had a perscription for 30 8mg zopfran disolveable pills. I went through those in 5 days, which was what the perscripton was wrote for. They gave me the generic version of zopfran which is ondansatron. But anyways, I call my surgeron on friday for a refill and on saturday when I call to pick it up cigna had denied the refill. They denied it sayin they need a authorization for the refill and will only pay this time for 20 pills. So I saw my surgeon today and asked him to call. They got the auth in and cigna paid for them but my surgeon forgot to write it for desolvables. So I have to crush them up, they are soooo icky to drink .But I am calling tomorrow to request for disolveables becuase I can't take them like this they are way too gross. So something to watch out for for your medications. But I didn't have to pay for any of my meds, cigna for me paid at 100%. So meet your deductibles. Than they will pay 100%. Hang in there.

Thanks for the info Krystle. I have Cigna and sure enough it took them 5 days to approve...well 5 days for me to be notified by the surgeon of approval. The IMO about medication is also very helpful. I'll keep that in mind when I have my VSG in a couple weeks.