Cigna 90 days medically supervised weight management

[Luigi5144 29]

For those of you with Cigna, I'm wondering how you did the 90 day medically supervised weight management.

[BeagleLover 1,020]

I went to my 3rd NUT meeting. A woman there said she was not approved since the medically supervised diet was not done by a doctor. It was a different insurance, but, just to be on the safe side, I suggest that whatever program you pick, call the insurance company beforehand to make sure it fits their requirements.

[Luvin_Life125 558]

I have just started my 90 day medically managed diet with Cigna. The most important thing you need to do is schedule 4 appointments with your primary care provider. They must each be at least 30 days apart. At each appointment your doctor MUST document:

-your weight

-your current dietary program

AnD

-your current physical activity program or exercise program

For the current dietary program you must be specific ie: weight watchers or 1500 calorie diet or whatever your program is. It is very important you keep track of you daily food intake (either an app on your phone or even a written food diary). Cigna can request your documentation of your diet before they approve your surgery.

For your exercise program you must also make sure your doctor documents it in detail. My doctor has it noted that I am walking 1.5- 2 blocks 2-3 times a day at least 4 days a week. I document my daily physically activity in with my food. I use my fitness pal app and that works well for me.

You must make sure to do 4 appointments too. The Cigna policy states 3 appointments at least 30 days apart (>89 days) but you also need to consider that you have to have an initial appointment to start the process.

Make sure you look up the Cigna Coverage Policy 0051. This will outline all of the Cigna requirements for approval. I printed the policy out and put it right in the front of my binder for easy referral and to check off as I complete the requirements. You also want to make sure you get a copy of the summary plan description from HR at work. This will outline coverage and any additional requirements your specific policy requires. If your summary plan description has different requirements than the Cigna Coverage Policy 0051, the summary plan description makes the rules!

There is one additional thing to watch for with Cigna. My summary plan description requires my surgery be performed at a Cigna designated Center of Excellence. When I first searched for in network bariatric surgeons I found a list of 20 providers within 75 miles of me. (I live in the middle of nowhere) I scheduled an appointment with a surgeon an hour away and was thrilled to get a surgeon that close to home. However, despite all of the in network surgeons in my area, the closest Cigna designated Center of Excellence is a little over 3 hours away. If your summary plan description requires a center of excellence please pm me and I will walk you through finding one because it isn't easy to find.

I hope I didn't overwhelm you. If something is not clear, please let me know. I spent many years working in medical billing so this is second nature to me. Keep in touch! You and I will be having surgery close to the same time.

[Jersrose43 837]

Finding a Cigna Center of Excellence is easy, register on mycigna.com for your plan.

Then search for a doctor/hospital, etc, and there are several filters.

Search by Procedure, then enter bariatric surgery, then your city

the COE come up at the top of the list -- St Agnes, Univ of Md, Baltimore General, and more

Good luck to you!

[Luigi5144 29]

@@Luvin_Life125 That was So detailed and helpful. Thank you. I have one more question for you. Is cigna one that they just consider your starting weight at the initial appt? Or do they base it on your bmi at the end of the 90 days?

[Luigi5144 29]

@@Jersrose43 Thank you for the tip. The bigger hospital in town is a Cigna Center of Excellence.

[Luvin_Life125 558]

I am not sure about the weight Cigna uses. My plan is to lose what I can preoperatively until I get to 40 BMI. If I make it down to a 40 BMi, I will maintain that weight just to be on the safe side.

As for the Cigna Center of Excellence- the hospital has to be a Cigna Center of Excellence in. Bariatric surgery if your plan requires the Center of Excellence. To check if it is a bariatric center of excellence,

On mycigna.com search "center of excellence" and choose facility

When the list of facilities comes up;

click on the center of excellence hyper link in each hospital that comes up

They will have different specialties listed. You will need to find one with bariatric surgery listed in the center of excellence hyperlink.

[Luvin_Life125 558]

I have almost met my out of pocket max for the year and want to be certain I can get my surgery done before the end of the year. I have spent a lot of time on the phone with Cigna and reading the summary plan description. I am not taking any chance of missing something or doing something incorrectly. I have questioned the Cigna reps up and down to make sure I am covering all of my bases. You are more than welcome. I am happy to share what I have learned!

[Jersrose43 837]

They use 35 bmi and comorbidities for approval. Or 40 bmi with none. I don't believe they require you to lose weight Just monitored for >=89 days

[Luvin_Life125 558]

They use 35 bmi and comorbidities for approval. Or 40 bmi with none. I don't believe they require you to lose weight Just monitored for >=89 days

Thanks! Do you know if degenerative joint disease of the spine falls under comorbidities?

[Jersrose43 837]

Documented back ailments may classify.

I would have the doc clearly state you have had it and how long

[Luigi5144 29]

@@Luvin_Life125 Did you have to submit last two years worth of medical records to cigna?

[Luvin_Life125 558]

Nothing has been submitted to Cigna yet. I am still working through all of the pre requisites for surgery. I have not read anything about 2 years of medical records being needed. At this point, I will send Cigna just about anything they want to get the surgery approved and scheduled before the end of the year. Did you have to submit 2 years of medical records?

[Jersrose43 837]

If your employer purchased a rider it may require the medical records. But not usually for cigna

[Luigi5144 29]

@@Luvin_Life125 my hopefully future surgeon's insurance girl told me that cigna requires previous 2 years worth of medical records to prove bmi was steadily 35-40, I thought that was strange. I called cigna and asked specifically. They told me that that wasn't the case. That what the coverage policy states are their only criteria and the only records they request. And, he told me that it was updated in May, so it's current