Question for CIGNA ("Open Access Plus")carriers

[kacee 3]

I have Cigna and a requirement of their's is that you be on a doctor sponsored weight loss program for a minimum of 6 months. I have not done that. However, I have hypertension, high lipids, high cholesterol, pulmonary hypertension, obstructive sleep apnea, and diabetes runs in my family. Has anyone else not had to fulfill that requirement? You'd think the medical issues might be considered more important.

[faithmd 14]

I cannot speak to Cigna, but I have also not heard of anyone who was able to bypass any length of time requirement.

Mine is 12 months MD supervised program. The important thing to remember is that they will be laying out a lot of money for this procedure and they want to know that you can follow a physician's advice and orders. The goal of the MD supervised weight loss is not to then say they won't pay for it if you are able to lose weight with the program, but to teach you good eating habits, etc.

One other word of advice, if there is also a weight loss requirement with that 6 month program, you MUST lose it. My insurance company requires 5% loss of excess weight in addition to the 12 month program. I was sick over my 12 months and because of meds I was on, I gained quite a bit of weight. I was then able to lose about 20 lbs (of almost 30 that I had gained) before I applied, but I was denied because I didn't lose the original 5%. My insurance takes your starting weight at the beginning of the MD program and then you have to lost 5% of the excess of that. I have to make it to 335 and apply again.

[micalyee 0]

I have cigna and i have not had any luck getting the surgery approved. June will be a complete year that I have tried to get approval and i am on my fourth appeal. my advice is to stick with it and fight to get he approval. make sure your get everything in writing from them.

[Big As Life 0]

I had no luck with CIGNA....I tried to get it approved, but they wouldn't even discuss it...they just out and out said, "NO" ....We no longer have CIGNA insurance...we now have First Health...and they want pay for it either...I am a self-pay....but worth every single penny...

[Sooverit! 1]

Dear Mic and Violet: Why wouldn't Cigna pay? ...looks like Violet you had the BMI for it? Micalyee what your numbers? I thank you both in advance I have Cigna and I'm starting a doc supervised and don't want to end this is yet another disappointment.

Thanks

Marg

[kacee 3]

Wow, if you guys can't get approved I can't see that they will approve ME. My BMI is 38, but my co-morbidities are numerous. I am fully prepared to self-pay, but my surgery is scheduled for May 23 and I would LIKE to have more than a few days notice to get everything together. The doc sent the paperwork in on April 19 and no word yet. They said that usually when you are denied it's pretty quick.

[tanderson 3]

I have Cigna and a requirement of their's is that you be on a doctor sponsored weight loss program for a minimum of 6 months. I have not done that. However, I have hypertension, high lipids, high cholesterol, pulmonary hypertension, obstructive sleep apnea, and diabetes runs in my family. Has anyone else not had to fulfill that requirement? You'd think the medical issues might be considered more important.

Kacee,

My surgeon's office told me that if you meet their criteria and submit ALL paperwork they require, that usually they will approve. Make sure that you have all of your ducks in a row prior to submitting. If your Cigna plan requires supervised weight loss for 6 months, then yes, you will have to complete that. I know it sucks...I too felt that it was useless to once again fail at a diet, but that is their requirement. I also included a detailed chart that listed all of my past diet attempts, you know the whole gamut, with beginning and ending weights, the diet type, exercise, and how many pounds lost. I really feel like this helped with my approval. Good luck!

Peace Out!

T~:hippie: