Cigna Insurance

[Jersrose43 837]

Center of excellence is normal saves more money. The 6 months is odd. Call Cigna directly and confirm that. Don't rely on the doc coordinator

[DeeSleeved427 7]

Center of excellence is normal saves more money. The 6 months is odd. Call Cigna directly and confirm that. Don't rely on the doc coordinator

I've called CIGNA like 5 times. Once just in hope that maybe the rep I got would say 3 months like the policy says, lolol. But each rep said 6 months dr sup diet, and only once did someone say center of excellence which is why I had to switch bariatric surgeons so late in the game (in month 5). What do you think I should ask exactly, maybe I'm asking the wrong questions-but the surgery coordinators for both my old and current center got 6 months from them too ????

[Jersrose43 837]

Are you speaking to customer service when you call or are you telling the computer it's in regards to authorization? Tell computer authorization after medical

Then tell them tou are reading the policy (I posted link earlier in this post) and that it reads three months

Ask them why your policy requires 6?

Is it your employer or the third party payer policy?

[DeeSleeved427 7]

Are you speaking to customer service when you call or are you telling the computer it's in regards to authorization? Tell computer authorization after medical

Then tell them tou are reading the policy (I posted link earlier in this post) and that it reads three months

Ask them why your policy requires 6?

Is it your employer or the third party payer policy?

It's my employers hmo plan offering.

Edited October 4, 2014 by DeeSleeved427

[DeeSleeved427 7]

Are you speaking to customer service when you call or are you telling the computer it's in regards to authorization? Tell computer authorization after medical

Then tell them tou are reading the policy (I posted link earlier in this post) and that it reads three months

Ask them why your policy requires 6?

Is it your employer or the third party payer policy?

Sorry, hit send too fast lol. I had only been calling customer service and they keep reading my plan requirements, most match the guidelines you posted except the 6 month and center of excellence being mandatory or they wouldn't cover it 100% like my plan says it will.

[Jersrose43 837]

Your employer can require more than normal but the 6 month is a little unusual that's why I asked if it was a third party. We sell to other insurances and they use our rules and networks and administer some additional authorization rules

[DeeSleeved427 7]

Your employer can require more than normal but the 6 month is a little unusual that's why I asked if it was a third party. We sell to other insurances and they use our rules and networks and administer some additional authorization rules

Thanks so much for all your help! I tried getting to authorizations but the lady didn't help me, she kept saying only the surgeon could call for pre-certification but I told her I wasn't trying to get certified but just confirm the requirements. Lol. I just ended up having hw transfer me back to customer service and the gentlemen said 6 months again. Lololol. I'm a week away from that last appointment so I'm just going to give up. I am now trying to get clarification on absolutely having to having the surgery at a center of excellence. There's only one close to me that is recognized but some good hospitals closer to me that aren't "Coe for bariatric".

[Donald Organ 1]

Just wondering if anyone has been approved with less than 89 days of weigh-ins? Both my wife and I are going through this process right now and he surgery ($$) is being taken care of so we're hoping that we can both get approved in time to have surgery in December, as her surgery would put us at the out of pocket maximum for the year and then my surgery would be free. Our initial consultation was on 9/29 and they did a weigh-in as well. The surgeon has told us that we would only need to more weigh-in appointments to fulfill the inssurance requirements even when i question him about 89 days. Yesterday at the pre-op class though the nurse said it had to be 89 days and that we would probably need another weight in in december before submitting to the insurance. Which would mean that the surgery would not happen until 2015, and then it means having to hit the deductible all over again before we can even consider the possibility of financing my surgery...

So just wondering others experiences with this....

[mrsmith901 18]

Just wondering if anyone has been approved with less than 89 days of weigh-ins? Both my wife and I are going through this process right now and he surgery ($$) is being taken care of so we're hoping that we can both get approved in time to have surgery in December, as her surgery would put us at the out of pocket maximum for the year and then my surgery would be free. Our initial consultation was on 9/29 and they did a weigh-in as well. The surgeon has told us that we would only need to more weigh-in appointments to fulfill the inssurance requirements even when i question him about 89 days. Yesterday at the pre-op class though the nurse said it had to be 89 days and that we would probably need another weight in in december before submitting to the insurance. Which would mean that the surgery would not happen until 2015, and then it means having to hit the deductible all over again before we can even consider the possibility of financing my surgery...

So just wondering others experiences with this....

My surgeon's office & the people I have spoken with to at Aetna were pretty firm on it had to be over a span of 89+ days. I have to see my PCP and weigh in a total of 4 times. I just had my first weigh in on Sept 26 so I plan on going for my last one December 27th.

[Jersrose43 837]

For Cigna you really need 89 days.

Look back thru responses I have attached the medical policy

[Donald Organ 1]

OK, is there any harm in submitting after the 3rd weigh-in, and seeing if it gets approved and if not then have a final weigh-in and resubmit??

[Luigi5144 29]

@@Jersrose43 Do you know if Cigna just looks at the 89+ days or do they need the dietitian appts to be exactly a month apart? My First dietitian appt/eval was on 7/15. 2nd appt was on 8/19. 3rd appt was on 9/23. My last appt is scheduled to be on Oct 15.

1) 7/15

2) 8/19

3) 9/23

4) 10/15

If I have done my math, correctly, it's 92 total consecutive days. More than a month between each appt except for the last one. Do you have any idea if that matters?

[Jersrose43 837]

You should be ok that is how I had mine. At least one a months. Not two in same calendar month

[Jersrose43 837]

OK, is there any harm in submitting after the 3rd weigh-in, and seeing if it gets approved and if not then have a final weigh-in and resubmit??

Donald if you submit and it hasn't been 89 days it will likely be rejected.

Once you get a rejection the next step is not a resubmission it is either a peer to peer review or an appeal from your provider. Both take longer than the normal first time submission

Trust me that I totally understand the oop dilemma. I really feel it since I had $9000 of it myself and so was pushing for everything in this one year.

I would suggest you get together any medical records that show you've been treating with a physician and medically monitored this year before the surgeon and see if they will consider that. Your surgeon will know.

Also call your insurance. Sometimes employers allow any deductibles incurred last month of the calendar year to carry to the new year. Long shot but worth a try.

[twhite85 1]

I am all scared I will get denied. My dr has had me on phentermine since May and has documented that we discussed weight and how I needed exercise and clean diet 1500 cals on one of the office note. We have May and June. I missed July bc my work wouldn't let me off but my dr documented that and I was seen in August and September. I'm scared that her notes are too vague we discussed other things but she always threw in my weight and how I needed to look into WLS and how I needed to watch what I ate and exercise. No specifics on exact diet and exercise. Problem is my employer only allowing me off the last week of October. Due to people having babies and other surgeries they can't give me any other time off before next year so if this doesn't get approved in screwed. ????