Finally approved-CIGNA

[CCRNonherway 78]

All I can say is make sure your submission follows their requirements to the exact letter!!!

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

I was denied my first submission and approved on appeal. The process took about a week each time.

Quirky points: Your doctor must BOTH clear AND recommend you for the surgery. The supervised diet must be documented monthly for a duration of >= 89 days and contain documentation of diet, exercise and weight EACH month. Summary reports are not acceptable, even if each visit is detailed in the summary.

My coordinator tried to reason with them but they would not budge until it was in the exact format they wanted.

Nit picky she said!

I'm so excited this is finally approved! In the scheme of things it went very quickly. Now Surgery 6-25! Eek!

Sent from my iPad using VST

[evansmini 8]

My husband was recently denied by Cigna, The dr's office is in the middle of appealing and I'm trying to make sure they do everything correctly.

Your doctor must BOTH clear AND recommend you for the surgery. Is this the PCP? I'm not sure what the dietitian has submitted to Cigna, but we go tomorrow to get a copy of what was sent. I'm will also be apply soon with Cigna to have the sleeve done, so we are trying to make sure his paper work is right before our. Any advice you could give would be great. Cigna has been so rude to me and even hung up on me once. This has been pretty frustrating

[CCRNonherway 78]

The policy states that another doc (not the surgeon) must clear you for surgery and recommend you for surgery. The policy is very clear on what must be submitted. Have you reviewed it?

So sorry to hear about your troubles. Just be persistent and eventually you will meet all the requirements.

[evansmini 8]

I've reviewed it every which way is possible. Meet with the Dr's office yesterday, apparently they were not aware of the 5/15/2013 policy changes. Traditionally when the filed with Cigna they only did 3 consecutive months of Dietitian visit. The newest version of the policy is MUCH more specific and now includes the >= 89 day. I don't have the prior policy so I can't confirm if that is true or not, but just a few additional hurdles for us to go through. I'm confident things will work out, we do see a COE, so they should be familiar with fighting these things