Cigna OAP require 3 or 6 month for approval

[JacobsMommy 27]

Does anyone know if Cigna requires 3 or 6 months of diet before approving? My insurance says 3 months, but my doctors say 6 months?? So, so confused!

[Bufflehead 6,358]

It varies depending on your insurance plan, i.e., your employer/administrator, not just Cigna. Cigna has lots of plans with different requirements. You should have a member benefit handbook that spells out exactly what YOUR Cigna plan requires. If not, get in touch with HR or your insurance administrator and ask them for one, or for a web link to one. If Cigna tells you something on the phone, make sure they confirm it in writing and that it applies to your plan specifically. I speak from hard experience here! Cigna does not always have reps that know wtf they are talking about on the phone!

[Andrew0929 1,101]

I have CIGNA and their requirements are vague and may be interpreted different ways. My surgeons office first interpreted as 3 months of nut but ended up being 4 months. A while back they did require 6 months of nut diet.

You can review their policies at: https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[JacobsMommy 27]

OMG Andrew0929, this information is very helpful. I am going to take this to my next appointment. This is what I've been looking for!! Bufflehead (like you said) I am going talk to my HR rep and take this info to my next appointment. I just don't want to prolong the surgery if I don't have to, especially if I have four months under my belt already. Wow, I needed this info badly! Thank you!

[jtickle 295]

I had a similar situation. My doctor was telling me I needed a 6 diet and of course I argued with them about it. I finally got my requirements in writing, sure enough no diet or psych evaluation. Just have to go to a bariatric center of excellence, be over 18, and bmi over 40. My info goes to insurance sometime this week. I started everything on March 3rd. I am excited but worried I am going to be denied. I guess these are normal feelings.

[SparkleCat 521]

I have CIGNA and their requirements are vague and may be interpreted different ways. My surgeons office first interpreted as 3 months of nut but ended up being 4 months. A while back they did require 6 months of nut diet. You can review their policies at: https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

Now I am freaking out a bit...my file is in reconsideration at Cigna because of the 3 month diet and 2nd physician clearance....my surgeon thought they didn't see the documents now I'm concerned about the time periods. I have a signed release from my pcp and can get a care summery recommending surgery, but my 3 month diet was February 2nd, March 2nd and April 1st....surgery scheduled for April 22nd. If I am understanding this document correctly, I don't have enough diet days.

Crap Crap Crap!!!

[JacobsMommy 27]

Wow, SparkleCat, I hope everything work out for you. That is a concern for me also. If I have to go through the 6 month period, I cannot have surgery until after June 10th. But if it is 3 months, like the documents said, I have four months under my belt and hopefully I can get approved. I will see next week.

[Jersrose43 837]

Now I am freaking out a bit...my file is in reconsideration at Cigna because of the 3 month diet and 2nd physician clearance....my surgeon thought they didn't see the documents now I'm concerned about the time periods. I have a signed release from my pcp and can get a care summery recommending surgery, but my 3 month diet was February 2nd, March 2nd and April 1st....surgery scheduled for April 22nd. If I am understanding this document correctly, I don't have enough diet days. Crap Crap Crap!!!

I read it as you have the requirements. You have 3 consecutive months (feb, March, April in less than or equal to 90 days)

The only thing am not sure about is your 2nd doc. Did you get a letter from your PCP recommending surgery and medically clearing you for surgery?

[SparkleCat 521]

I read it as you have the requirements. You have 3 consecutive months (feb, March, April in less than or equal to 90 days) The only thing am not sure about is your 2nd doc. Did you get a letter from your PCP recommending surgery and medically clearing you for surgery?

I definitely have the pcp clearance letter and recommendation ..but I thought it was > or = (great than or equal to) 89 days ?

God I hate insurance! Legalized extortion....and we pay through the nose to jump through arbitrary hoops set up by a system that is designed to be more concerned with profit than health.

[Jersrose43 837]

Yes you're rigt I misread. So you may need one more visit? Maybe?

I can't see them being that particular but I am also on reconsideration with Cigna right now

But it's because insurance coordinator messed up and did not send any documentation with the request.

[JacobsMommy 27]

I have my pcp letter of approval/recommendation. I will submit everything next Tuesday after my pre - op class. This crap is nerve wrecking

[JacobsMommy 27]

I have my pcp letter of approval/recommendation. I will submit everything next Tuesday after my pre - op class. This crap is nerve wrecking.

[cherrytree15 78]

My stuff gets submitted to Cigna tomorrow. I has the 3 month wait period. My surgeon seems to be listed as preferred bariatric provider so I am hoping this helps. I'm so anxious and getting stressed. I am confident that it will be approved quickly, I'm going to stay positive. Pray got me folks!

[JacobsMommy 27]

I spoke to my surgeons coordinator and she told me again today that I needed to wait six months. I asked her to submit the paper work next week after my pre-op class just in faith to see what happens. She was persistent in saying I needed to wait six months before she would submit the paper work because everyone who has Cigna insurance beginning with an "U" all were denied. I asked her to submit it anyway and we will go from there. SMH....She also said that Maryland requires 6 months although Cigna requires 3 months...that doesn't make sense at all....I am officially discouraged and frustrated.

[SparkleCat 521]

I spoke to my surgeons coordinator and she told me again today that I needed to wait six months. I asked her to submit the paper work next week after my pre-op class just in faith to see what happens. She was persistent in saying I needed to wait six months before she would submit the paper work because everyone who has Cigna insurance beginning with an "U" all were denied. I asked her to submit it anyway and we will go from there. SMH....She also said that Maryland requires 6 months although Cigna requires 3 months...that doesn't make sense at all....I am officially discouraged and frustrated.

That sucks!! But it's not "no"...it's just "not yet".

I will hopefully find out tomorrow about my reconsideration...they didn't answer the email I sent today.

Did I mention how much I hate insurance and what a scam I think it is?