Cigna Revised Policy

[Nikki613 120]

if you read what I highlighted in red you will see that the requirements are:

1. You have participated in a minumum 3 month supervised diet in the last year.

2. the rest of the evaluations must have been completed in the last 6 months, this is your recommendations /clearances ect.

[mel2643 68]

Thank you Sleeveme81 .... Now I am all the way confused ... But i will contact my surgical cordinator and find out

[mel2643 68]

Well my apologies to everyone .... As yes it is true and since I am on my thrid month they will be getting started on the submittal for approval

[Wheetsin 714]

I know this answer doesn't help, but it depends. Mostly on the hospital. Insurance companies don't really care about copays since they're between you & the physician. Your insurance company doesn't even know if you've paid the copay or not. Deductibles on the other hand...

My hospital copay was due when I pre-registered. I paid it in full, but was asked to pay at least half and pay the other half prior to surgery. I don't have a deductible oran OOP maximum. Just last week I received a bill for a copay on my surgeon's fee, but the copays for all of his office visits had to be paid at the time of the visit.

When we go to the ER at our local hospital, we are billed our copay about 4 weeks later. When I went to the ER where I had my surgery (since it was directly related and I figured the smarter option) a lady actually walked in after I'd been in a room about 5 mins, literally interrupted me telling the nurse what was wrong, and wanted full payment of my copay right then and there. She even had a portable payment machine strapped to her chest.

Can anyone help me with how I must pay my deductible an so forth. I have Cigna as well. Cigna said I will have a hospital copay of 250 a deductible of 200 and my Out of pocket is 1500. Do all these monies have to be paid in full before surgery can take place?

[Wheetsin 714]

The two parts you posted are referring to different things, I believe.

Justsleeveme23 , I also looked at the policy but where you write its on top of page 2 ( Medical management including evidence of active participation within the last 12 months in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of three consecutive months. ) is talking about a weight management program .... This is the "supervised weightloss"...

However the next bullet states the 6 months

A thorough multidisciplinary evaluation within the previous six months which includes ALL of the following: WITHIN the previous six months, meaning these all have to be completed no more than 6 months prior to your surgery date. This has nothing to do with a 6 month supervised diet.

 an evaluation by a bariatric surgeon recommending surgical treatment, including a description of the proposed procedure(s) and all of the associated current CPT codes This is standard surgeon recommendation, which should be a no brainer.

 a separate medical evaluation from a physician other than the requesting surgeon that includes both a recommendation for bariatric surgery as well as a medical clearance for surgery This would be your referral, as from a PCP. Do you have an H M O? (board is censoring it without spaces, weird... I know H M Os suck, but come on...! Referrals are normally only required by H M Os.

 unequivocal clearance for bariatric surgery by a mental health provider This is the standard psych eval...

 a nutritional evaluation by a physician or registered dietician " This is not the same as a "supervised diet." It is probably referring to a pre-op meeting you will need to have (mine was merged into a larger "information class") where they sit and talk with you about Protein, capacity, healthy habits, how many meals to aim for, etc.

[lisalalani 81]

Hey Cigna Sleevers!

I got sleeved March 28, 2012. I had to do the 6 mos thing. I got denied one time because they "lost" my doctor letter. I re-faxed it, and got approved right away. We ended up paying $4,400 total. $4,000 was my deductible and $400 for the hospital admit. It was SO worth it!!!! I really didn't have a hard time with Cigna at all. I am so happy with my sleeve. I am LOVING it! Good luck to the rest of you on your journey! I wish you well! <3

[mel2643 68]

Hey Cigna Sleevers!

I got sleeved March 28, 2012. I had to do the 6 mos thing. I got denied one time because they "lost" my doctor letter. I re-faxed it, and got approved right away. We ended up paying $4,400 total. $4,000 was my deductible and $400 for the hospital admit. It was SO worth it!!!! I really didn't have a hard time with Cigna at all. I am so happy with my sleeve. I am LOVING it! Good luck to the rest of you on your journey! I wish you well! <3

Did you pay the $4,400 upfront or did they bill you ? I think mine is $5000 because he is out of network

[lisalalani 81]

I payed $2,400 the day before and the $2000 the day of, so yeah, I guess it was up front. That btw, was just surgery, not all the psych eval, nut, and exercise classes.