Cigna 90 day diet requirement

[northmsgirl 3]

I thought my last visit was tomorrow, but am now devastated because my surgeons office is telling me I have to start over because I "skipped" October.

I went July 27, August 27, September 29, and have an appt for November 3. I could not go on Friday, October 30 which was the only business day that would have given me 30 days between visits but still have he last visit in October.

Any insight as to whether the surgeons office is correct and the 11/3 date is too late?? Thank you!

[WLSResources/ClothingExch 3,444]

It isn't a matter of "insight." It's about reading your plan's literature or checking its website. Or calling.

[northmsgirl 3]

Not an idiot. First thing I did when I started considering the surgery was read my insurance's literature, which I did again yesterday (both the brochure and coverage policies). They are, in my opinion, ambiguous and don't cover this exact situation. Also, my insurance company is closed right now, so I thought I could get some help in the meantime. So, yes, actually, insight is exactly what I need. If you don't have anything to offer, please don't feel like you have to respond. Thanks.

Edited November 3, 2015 by northmsgirl

[freemommy×4 65]

Oh man! I hope for your sake that they are wrong! All that hard work! I'm sorry I don't have any answers for you! Seems pretty unfair to me!

[Tobeornottobe 89]

I thought my last visit was tomorrow, but am now devastated because my surgeons office is telling me I have to start over because I "skipped" October.

I went July 27, August 27, September 29, and have an appt for November 3. I could not go on Friday, October 30 which was the only business day that would have given me 30 days between visits but still have he last visit in October.

Any insight as to whether the surgeons office is correct and the 11/3 date is too late?? Thank you!

I have Cigna and the requirement is a 90 supervised nutrition program. It is 90 consecutive days or 3 consecutive months. You missed October so it's not consecutive. So sorry this happened to you.

Personally, I CMA by doing 4 months, July, August, September and October to ensure there were no surprises.

HTH

[northmsgirl 3]

I thought my last visit was tomorrow, but am now devastated because my surgeons office is telling me I have to start over because I "skipped" October.

I went July 27, August 27, September 29, and have an appt for November 3. I could not go on Friday, October 30 which was the only business day that would have given me 30 days between visits but still have he last visit in October.

Any insight as to whether the surgeons office is correct and the 11/3 date is too late?? Thank you!

I have Cigna and the requirement is a 90 supervised nutrition program. It is 90 consecutive days or 3 consecutive months. You missed October so it's not consecutive. So sorry this happened to you.

Personally, I CMA by doing 4 months, July, August, September and October to ensure there were no surprises.

HTH

So, you think that I could only have gone on October 30 to meet requirement? But if I had gone September 3 I could have gone October 30? That just makes zero sense. It's only been like 96 days since my first appointment. And I've read that the visits have to be 30 days apart (like you can't go September 20 and October 3). I don't feel like I should be punished because my appointments were at the very end of a calendar month. I didn't skip a month.

I'm going to call them today and I'll update with what they say. Thanks for your insight, even if it was disappointing!

[northmsgirl 3]

Surgeon's office is checking and going to try to make it work!!

Edited November 3, 2015 by northmsgirl

[Tobeornottobe 89]

Awesome!! Good luck and let us know how things work out.

[WLSResources/ClothingExch 3,444]

@@northmsgirl

I offered based on what you presented. You then filled in more and I really do hope the others who have your plan gave you something concrete to work with.

Med plan lit is notoriously ambiguous by design. When you do call, be aware that, if you speak with four people, you may get as many different stories. Write down names. I don't think you're an idiot, but I know how easy it is to get excited/irate with "those people," hence, easy to skip noting what might be useful down the road.

If you can't swing it your way, just proceed toward the end you want most. I'm under the impression that it's more common for plans to require a six-month supervised diet, so it could be worse. Good luck.

[northmsgirl 3]

@@northmsgirl

I offered based on what you presented. You then filled in more and I really do hope the others who have your plan gave you something concrete to work with.

Med plan lit is notoriously ambiguous by design. When you do call, be aware that, if you speak with four people, you may get as many different stories. Write down names. I don't think you're an idiot, but I know how easy it is to get excited/irate with "those people," hence, easy to skip noting what might be useful down the road.

If you can't swing it your way, just proceed toward the end you want most. I'm under the impression that it's more common for plans to require a six-month supervised diet, so it could be worse. Good luck.

I'm a lawyer. I document and read carefully by nature and training. Didn't mean to snap, but I was on edge last night anyway, and I just thought it was a little rude to not answer the question I was asking but instead tell me to read the lit. I didn't feel the need to preface my question with "I've already read the documents," because honestly I would assume most people would have already done that before asking a question about requirements.

Frankly, the answer to every single question in this forum is read the lit and talk to your insurance company. I was just looking to hear others' experiences/insight regarding the diet requirements. Thanks for being willing to help. I do appreciate it.

[northmsgirl 3]

G.

[WLSResources/ClothingExch 3,444]

I'm a lawyer. I document and read carefully by nature and training. Didn't mean to snap, but I was on edge last night anyway, and I just thought it was a little rude to not answer the question I was asking but instead tell me to read the lit. I didn't feel the need to preface my question with "I've already read the documents," because honestly I would assume most people would have already done that before asking a question about requirements.

Frankly, the answer to every single question in this forum is read the lit and talk to your insurance company. I was just looking to hear others' experiences/insight regarding the diet requirements. Thanks for being willing to help. I do appreciate it.

Lawyer? Ha! Lawyers of past acquaintance suggested I pursue the field, but it didn't call to me. How could I have known I was preaching to the preacher? By training and probably by inclination, you're given to notes, mental or otherwise, and the prep work before advancing into the fire. As one who's worked with and marveled at humans in many settings, I can say with assurance that a great many would not do the basic research for themselves.

I do wish you well. If my plan had required supervised, pre-op weight-loss, I'd be happy to relate what I could. I hope you'll return with the outcome of your situation. It will be interesting to know if you were able to move the immovable and, if so, other readers would be helped.

[northmsgirl 3]

I'm a lawyer. I document and read carefully by nature and training. Didn't mean to snap, but I was on edge last night anyway, and I just thought it was a little rude to not answer the question I was asking but instead tell me to read the lit. I didn't feel the need to preface my question with "I've already read the documents," because honestly I would assume most people would have already done that before asking a question about requirements.

Frankly, the answer to every single question in this forum is read the lit and talk to your insurance company. I was just looking to hear others' experiences/insight regarding the diet requirements. Thanks for being willing to help. I do appreciate it.

Lawyer? Ha! Lawyers of past acquaintance suggested I pursue the field, but it didn't call to me. How could I have known I was preaching to the preacher? By training and probably by inclination, you're given to notes, mental or otherwise, and the prep work before advancing into the fire. As one who's worked with and marveled at humans in many settings, I can say with assurance that a great many would not do the basic research for themselves.

I do wish you well. If my plan had required supervised, pre-op weight-loss, I'd be happy to relate what I could. I hope you'll return with the outcome of your situation. It will be interesting to know if you were able to move the immovable and, if so, other readers would be helped.

I love lawyering. It's fun, and is perfect for me.

It's all in framing the issue. You have to give the decision maker the impression that you are on the side of goodness and right, and then give them the written authority to hang their hat on. If my program had been 89 days, it wouldn't have been acceptable. If I had gone to the dr on September 29 and October 20, it would not have been unacceptable. Even October 26 wouldn't have given me 90 days. It does not reason that 95 or 97 days is unacceptable, that October 29 or 30 were the only days I could go for my last visit, or that I could basically punished/denied for beginning this process at the tail end of a calendar month. I did not "skip a month." I know their job is to basically deny everything, but it's my job to back them in a corner with their own documents to where they can't!

I'll let everyone know how it goes. Thanks for the well wishes! Sorry if I've been edgy. I've been dealing with my insurance company on an unrelated issue and with other medical companies on assembling my records from 3 states and 3.5 years away. It sucks.

Edited November 4, 2015 by northmsgirl

[WLSResources/ClothingExch 3,444]

@@northmsgirl --

(1) How much happier the world would be if everyone felt the same about their work.

(2) Your first two lines? What a turn-on. I so relish a good game of cat 'n mouse now and then......Your "basically deny everything" rings a recent bell, but with regard to a city agency. I was injured while on its premises and foolishly thought their people on the scene and those in the offices with whom I had contact later were there to help me. I hate the phrase, but what a "teaching moment" that was. I'm gleeful, not proud, to imagine seeing one of them hurt and stopping to help as I was helped at the accident scene. (It's fantasy. I'd do the right thing. High on my list is being able to live with myself.)

(3) Edgy here, too, and sorry about it. Stand firm.

Edited November 4, 2015 by WLSResources/ClothingExch