Cigna Coverage - Borrowing Trouble

[Bufflehead 6,358]

So, I'm going to use this forum a bit to vent about my anxiety regarding coverage.

I have Cigna coverage, but the plan is managed by APS Health. It's one of those "partnership" plans where you get a discount on your coverage for participating in health coaching, getting regular health screenings, etc. I only started considering bariatric surgery when my APS health coach said I should. She told me to call Cigna and ask for their policy and information on bariatric surgery to learn about coverage. So I did. When I talked to Cigna, they had my account number and member number and said they were sending me all the relevant information on bariatric surgery under my coverage.

Cigna sent me their policy, which was changed in May of this year. It requires 3 months supervised diet (supervised by any physician or RD), PCP clearance and recommendation, typical BMI stuff, and a psychologist screening. So I get to work on these requirements. I am 2/3 of the way through my supervised diet (run through my surgeon's office), have done the psych eval, and have an appointment to meet with my PCP next week.

BUT last week I was looking around on the APS website for something else and stumbled on a separate document of their own on bariatric surgery. It says that they require: 6 months supervised diet and not supervised by a bariatric surgeon, and 5 years of documented history of obesity. So I panic and call Cigna and the rep there assured me that APS was wrong, and I just need to follow the current Cigna plan. Relief.

Then I got a call back this morning from a higher level manager at Cigna who tells me that in fact the APS document might be right and Cigna is researching it for me. I'll hear back from Cigna later this week or early next week.

I'm really terrified. Forget the fact that I've wasted my time and money on the weight loss program that will no longer count, and paid for psychological testing that my insurance doesn't even cover. I can't meet the five year requirement. For about three years I did not see any doctor at all. I did not go to Weight Watchers or anything else that documented my weight. I definitely was super-morbidly obese or whatever they call it, but I can't prove it unless they'll accept photographs and copies of receipts for ordering clothes in gigantic sizes.

Believe me I am very grateful to have insurance at all in this country, and hope that mine will end up covering this surgery. I can't afford Mexico or any other self-pay option. I really hope that I am panicking over nothing. I don't think I realized how much I want this surgery until this came up and I understood that I might not be able to get it.

[Back~To~Amy 307]

I'm sorry this is happening to you. However, you may have a case against them in honoring what they sent you in writing. If they come back on you with something different, I would argue it with them to try and get them to honor what they put in writing. If they say they won't, then file a complaint with the Department of Insurance in your state. You can Google your state's Department of Insurance.

Also, make sure you keep the original documents the insurance company sent you and keep records of the date and time of each call and who you spoke to.

Good luck to you. I hope it all works out for you!

[Alaina Sampica Miller 3]

I have cigna, and just had surgery. It required 6 months of consecutive monthly visits by a bariatric doc. need a letter from your primary care physical stating that you are medically clear for your surgery and that they support it. you also need to make sure you have your mental health evaluation within the 6 months of the surgery. Also the letter from you doc make sure its a DOCTOR not a physical assistant, thats where i ran into a lil problem. they didnt really have anything on me from the past years, but that didnt matter in my case. also after my paperwork was submitted they were very very very fast with approving my surgery. I thought cigna was amazing to deal with. I would call again and again. I called very often. So the info that I know i needed was

6 month consecutive visits supervised..

a letter from physical starting you are cleared for surgery

mental health eval

and thats about it if i remeber anything else I will let you know, and again i JUST had my surgery less than 2 week s ago

[traceyinflorida 499]

I got my PCP to put my diet and weight loss history in the letter of medical necessity. I wrote it out for her. There was no documentation of this, as I had not seen a physician in years. She had no problem with this and it cleared through Cigna. Good luck. I know it is frustrating!

[Bufflehead 6,358]

thanks everyone for the kind words and good tips. Hopefully all this worrying will be for nothing!