Cigna questions-frantic

[xrayyoung22 16]

I am finally finishing up my 90 day pre-op diet. I've successfully completed every other requirement by my insurance (psych evaluation, bariatric classes, nutritionist appt, etc) and my last pcp weigh in is in a week. I spoke to my patient advocate today to make sure my ducks were in a row for approval and she now says, for the first time today, that she needs medical records from 2013 and 2014 showing my BMI was over 35 since then. My BMI was under 35 in 2013 and nowhere in Cignas requirements (I've read the policy many times and called Cigna many times) does it say anything about needing two years of past records for approval. When I told the patient advocate this she told me they always ask for it. Does anyone have any info on this because I'm at the pre-op finish line and now this is thrown at me, and I'm devastated.

[_Kate_ 2,224]

I can't help with your question but just hope this can be sorted out for you and soon. Please let us know how you get on. Fingers crossed and send in you a virtual hug!!

Kate

[Jazziminna 95]

I also have Cigna. I'm in TX and no one has said anything about past bmi history. I'm 1 month into my 3 month wait and nut appts (1 down 3 to go). Haven't done psych eval yet. Just procrastinating. Good luck and keeps us posted on everything.

[Sharon1964 2,530]

Tell her you want her to submit without the records. If they ask for them, you can respond, in writing, that their written policy doesn't require it.

If they deny, appeal with copies of their own policy. It looks like "right" is on your side.

[nikkiperezcassar 36]

This is the exact thing I'm terrified of, some random requirement at the end of all this! My thoughts are with you, please let us all know how you make out.

[queencity 62]

As I'm researching my insurance requirements for surgery, I called bcbsnc to ask and they basically told me that I have to meet my surgeons requirments. I thought that they required 2 previous years showing bmi being over 40. As I go on my surgeons website they requirments does not include previous 2 years weight. Now that you mention this I will ask my surgeon.

[Babbs 14,680]

I have Cigna and they never asked for that. As a matter of fact, once my 3 month appointments, psych eval and NUT visits were complete and submitted, I was approved within days. After hearing horror stories, I was pleasantly surprised how easy it was to get approved. I would make her submit without that and see what happens. I think she is incorrect.

[3bzmom 96]

I also have Cigna. 2 years worth of medical records were required, but nobody has said anything about the BMI having to be over 40 (or 35 with comorbidities) for that whole time. My doc said Cigna will use the BMI from your first appointment in your 90-day series, but to be careful I didn't drop below 35 during the 90 days. (I'm a 36 plus several comorbidities.). I am in review with Cigna and should know by the end of the week.

[KDM74 186]

I have Cigna and I did not have to submit past records. I was initially denied because my 3 month visits weren't 90 days apart, but that was quickly reversed when they realized I had done a 4th visit precisely for that reason. Unless this is a recent change within the last few weeks? I just had my surgery on June 1st. Good luck!

[xrayyoung22 16]

Thanks everyone. I submit to insurance next week. I will keep you posted.

[jadama22 110]

i have Cigna too, but I was never told to submit any past history records. When i called Cigna 2 days ago to check on how long they would take, they said that the surgeons office had to submit the clinicals and it was sent over immediately, Cigna said they should have a decision for me in 5 days. crossing my fingers

[jadama22 110]

I am finally finishing up my 90 day pre-op diet. I've successfully completed every other requirement by my insurance (psych evaluation, bariatric classes, nutritionist appt, etc) and my last pcp weigh in is in a week. I spoke to my patient advocate today to make sure my ducks were in a row for approval and she now says, for the first time today, that she needs medical records from 2013 and 2014 showing my BMI was over 35 since then. My BMI was under 35 in 2013 and nowhere in Cignas requirements (I've read the policy many times and called Cigna many times) does it say anything about needing two years of past records for approval. When I told the patient advocate this she told me they always ask for it. Does anyone have any info on this because I'm at the pre-op finish line and now this is thrown at me, and I'm devastated.

i just wanted to repost to you - I have just been approved by Cigna and my package was submitted last week Thursday - technically speaking that is 4 business days! I did not submit any medical history of any kind other than my doctor probably stating in his letter that I have been trying to loose weight on different diets and he named them all for the past 5 years - but no records provided.

I agree with Babbs - have your surgeon office submit the package with what you have and if Cigna needs anything else - they will ask for it. Also just a hint. I called two days later after the package was submitted and Cigna said they had everything but my clinicals so I got right on it, made a call to my surgeons office and told them to submit immediately. Don't be afraid to call Cigna afterwards and ask what the status is. I have found that many others on the forum have done the same and have obtained the results faster than the doctors office.

Good luck!!!

[queencity 62]

Great! I have bcbsnc which I believe it takes 4-6 weeks to approved. When my surgeon submits everything to them I plan on calling every 3 days I guess lol

[xrayyoung22 16]

_{I just wanted to touch base with everyone on this. So, my paperwork was submitted last Wednesday. I was denied on Friday (less than 2 days later) but not because of past medical records but because Cigna didn't like the documentation of my 90 day supervised diet. My doctor submitted MORE paperwork specifically discussing diet, exercise, calorie intake, etc on every single doctor apt I attended in the past four months. It has been two days now and Cigna still has my file under the "reconsideration" category but with no answer. I don't know if this is a good thing or not but I'm praying that nothing else comes up and I will have an approval by next week.}

[KDM74 186]

You will get approved. I have Cigna too and the same thing happened to me. They needed more documentation of my doctor visits. I was approved within 4 days of resubmitting. You will probably hear back by Monday. Kudos to you for sticking it out. The insurance is the hardest part some times.