Insurance six month supervised program

[jcg3800 0]

Hi, I have Cigna Insurance and they require me to be involved in a six month physician supervised weight loss program prior to approval for surgery. How have others handled this? This is so foolish but mandatory. Thanks. Jan

[janiee 0]

Yes, I am starting the Ins demanding, six month "telephone coaching program" tomorrow.

I can let you know how my first appt went if you would like

BTW I have Pacificare HMO

[terrriho 0]

Yep, I have to do a six month doctor supervised diet designed to see if I won't go away or change insurance companies in the mean time. I wonder if you wanted your tubes tied if they would say spend six months using the rhythm method to see if you can keep from getting pregnant :angry I have my first appointment with my PCP Dec. 8 and we will jump through their ridiculous hoops. Yeah, I am mad........but I have company. By the way, Horizon BCBS of New Jersey.

janiee- tell me about your "telephone coaching program" I hate the idea that I will have to take time off work (even though a short visit, it will still take and hour) and pay $80 out of pocket (the insurance company sure has h3!! isn't going to pay) for my monthly appointments. I do have a nutritionist I can do phone consults with, is that what you will be doing?

Oh, and by the way, I have it on good authority that you must make every appointment or you will have to start over.:nervous

Best of luck on your journey,

Terri

[jcg3800 0]

that is so true about the hoops we must jump through. I never heard of a telephone coaching program. I love your sense of humor.

[LuckyGirl 1]

I just got approved after the six month waiting period and I think what they want is really 6 months of doctors visits. That means once a month for every month. At first i had a year long wait and thought i would go every 2 or 3 months. Later they switched it to a 6 month period and they only counted the month that I started having appts. every month afterward. So I went in Dec then march and june and august - then found out that people who were getting approved went every month. So i started in August, went every month after that and got approved in Nov. also, make sure your doctor documents everything and as neatly as possible. some doctors dictate - mine handwrote and she wasn't that "wordy" but luckily they took it... good luck!

[janiee 0]

Well, I just got off the phone with the telephone coaching program. The woman was very nice and I have to talk on the phone with her once a week for 6 months. She is going to send a cook book,journals,excercise tapes,nutrition bars,ect.. and I need to track myself on their website so she can see my progress. She is also going to send a bunch of info about the lapband and info about how to get emotionally and physically ready for the surgery...So it actually sounds pretty good.

[kathyy68 0]

I also have Cigna and I am in my last month of my 6 mos diet. Just make sure you actually go 6 months and not to just 6 Dr. visits. Six Dr. visits is only 5 months technically. I have completed my psych exam, nutrition counseling, and physical exam. All I have left is one more appt. and we can re-submit my info. YIPEE!!! Im hoping for a January date.

[Oneday 0]

I am new to this site, and so very happy to be here. I messed up last year everything was ready to go for my surgury and I cancelled "I was sceared". So now my insurance changed and I have had to do the 6 month diet:think . So I go for my first appt. on Dec. 14th.

Do they want to lose and then say sorry you can do it on your own or what is the point to the 6 month diet?

[jcg3800 0]

One day-my understanding is that Cigna wants to see that we have the commitment needed to be successul after the surgery so they require this. Also they want you to loose weight 10% if possible because it has been proven that even 10% loss will be beneficial with less complications. Jan

[Kat817 19]

My insurance (BCBS ofTX) required a 12 month medically supervised program with bi-monthlymeetings with a nutritionist. Well our first fight was that in our rural area there is no licensed nutritionist for me to see...so they finally agreed to let my Dr. handle it. I did 10 1/2 months of visits with the Dr. every 4 weeks, and ended up in a car accident (not my fault). I was injured, and ended up in surgery for some repair work to my knee. When I was out of the hospital, I went to my next appointment where the Office Manager informed me I would be starting my 12 month program over again...that it has to be 12 consecutive months of steady visits. I was crushed!!!

I appealled it, and was denied again. By the time the denial come through I had done 12 months...just not consecutively. So I appealled it again...denied. I likely should have got an attorney and fought it harder...but instead went self pay....with my settlement from the car accident.

Was it worth it???? YES!!! YES!!! YES!!!!

Kat

[flabuless 18]

Kat 817...Gosh Kat how fustrating!! Gee I would have hit the roof if that happened to me...I prob would have taken them to oprah hehehehe!

becky

[Kat817 19]

Believe me Becky, I was livid---but I just wanted it done! So I could regain my life. Besides, I am not too sure Oprah would have been very sympathetic...she doesn't seem to be much for WLS......

Thanks for the sympathy tho!!! Just glad I did it, and it is working!!!!

Kat

[flabuless 18]

hehehe thats only because oprah has the millions of dollars necessary for a high tiluting personal trainer and a food slapper! hehehe I only recently found out what a food slapper is....

becky

[janiee 0]

What is a food slapper?!!LOL!!

[flabuless 18]

It is someone that 'rich' people have that follow you around and slap your hand everytime you reach for food...