Cigna 6 month MD supervised diet

tanderson · August 9, 2006

Hello everyone,

I am new to this forum and have just recently started considering the Lap Band, (seriously) in the last 18 months. I see my Doc on a regular basis for ailments caused by my obesity, i.e. low back pain, knee pain, etc... and I have mentioned to him on more than one occassion that I am considering the lap band. Each visit, sometimes not on a monthly basis, my weight is documented. I even had a hospitalization in November of last year due to adverse side effects of the diet drug Fastin which caused me to have a positive EKG and hence an emergency heart catherization. My question is, has any one out there who has Cigna EPO been approved without consistent monthly weigh ins with their Doc for a medically supervised diet? Or can anyone give me insight on their experiences with Cigna...thanks!

kaybee · August 9, 2006

Hello and yes, I had to do the 6 months with Cigna. They seem to be pretty much looking for 6 months of a consecutive "attempt" at losing some pounds . They want to see a doctor's notes that you visited for obesity and are trying to follow a weight loss program. If "weight" was mentioned at each of your visits, maybe they will accept it. I was minus 1 month of a doctor note, but they ok'd me to go. The months of waiting are the most agonizing and longest days as you just want to get the whole thing over with. Be patient, easier said than done, but will be worth it in the long run. You can always submit your paperwork and then they will let you anything else that is needed before the final submission. I worked with a case manager who was very helpful . Maybe write a letter of your thoughts on why you NEED this surgery to submit along with your doctor and your surgeon's recommendation. GOOD LUCK..........I was banded 4/18 and I am a total of 58 pounds lighter !!!!

Constance · August 9, 2006

I am actually appealing a denial with Cigna based on the 6month supervision being 'inadequate'. From what I have learned, they want 6 months, "without significant gaps" over a 12 month period. So I think you could probably skip a month, maybe two. But ultimately they are looking for each month to have your vitals, weight, blood pressure, etc., the diet and exercise plan you have been using, and any things you and you doctor talked about related to that. Also, I think they like to see doctor reccomendations, like, "Patient asks about joint pain. I advised low weight bearing exercises". You know, something concrete that was discussed.

You can submit what you have - however you only get 3 appeals so proceed wisely. They denied me for what it seems is nothing. Litererally, we can't figure out what this denial is actually about since I have the 6mo documentation. But they claim I am 'missing' 2 months. So obnoxious! If you have chosen a surgeon they may have someone on staff who does all the insurance processing for you. That makes things easier and that perosn can guide you in the process. If you are going it alone, Cigna has a list of their requirments in PDF on their website...I'll see if I can find it for you.

Good luck!

Constance · August 9, 2006

Here is the link for the Cigna surgery requirements:

http://www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

kickiegirl · August 10, 2006

I also am in the struggle with Cigna. Apparently you have to have 6 months consecutive dr visits....blah blah blah included. However, I have employed the help of Walter & Kelley Lindstrom (the obesity lawyers)... they have advised me on several issues. Also, Inamed, the manufacturer of LAPBAND, has a new program where if you are denied approval and they feel you have a good case for LAPBAND surgery they will cover your lawyer fees. I don't know where you are located, but the center where I found my surgeon is wonderful. NorthWest Weighloss Surgery Center. They have helped me through the whole process thus far and are pros at what insurance companies want to see etc.

Here are some helpful links for more info

http://www.thelapband.com/FlashHome.cfm?pagename=mm1

http://www.obesitylaw.com/

Good Luck! Don't give up!!!!

tanderson · August 10, 2006

Thanks to everyone who has given me advice. I found it to be very hopeful and informative. I have an appointment with my surgeon on August 21st...wish me luck!